What does a person who commits Medicaid fraud look like? We probably all have preconceived notions. And we are probably wrong!
Medicaid fraudsters come in all races, ages, gender, nationality and skin colors. Education isn’t a factor either. Everyone from high school dropout “patient recruiters” hustling the streets to Ivy League trained doctors have been convicted of healthcare fraud.
The FBI says that the 10% of our healthcare dollars are being lost to fraud. In some areas of the country, such as Chicago / Naperville, the rate of fraud is much higher.
When the Illinois State Police recently announced the conviction of five women for Medicaid fraud, we were intrigued by their booking photos. Their stories and photos appear below.
Cynthia Evans - Rockford, Illinois
Cynthia Evans worked as a personal assistant helping homebound patients with daily living activities. She stopped working as a home health aide in April of 2013. Unfortunately, she continued billing Medicaid as if she was still seeing patients.
Last month, Evans’ trail of deceit ended. She was convicted of felony vendor fraud in Dekalb County and must also pay restitution.
Judy Melchor - Freeport, Illinois
Kattie Sanders
Starvainea Sanders
In 2013, the Illinois State Police Medicaid Fraud Control Unit began investigating Judy Melchor. Employed as a home healthcare worker, prosecutors say she was billing for services never provided. Melchor’s alleged patient was either away, in a nursing home, in a hospital and at one point, in jail!
Both Melchor and the patient, Kattie Sanders, have now been convicted of Medicaid fraud and must reimburse taxpayers tens of thousands of dollars.
Another home healthcare worker, Starvainea Sanders, was also convicted for her role in the scheme.
Lisa Opinga - Rockford, Illinois
If you think the above Medicaid fraudsters were brazen, Lisa Opinga’s scheme was even more brazen.
Prosecutors say that Opinga billed Medicaid for over a year while her alleged patient wasn’t even in the United States. Opinga was billing services for a patient who was in the Philippines.
In June Opinga was sentenced to probation and restitution.
Illinois Medicaid fraud is a felony. Those who commit healthcare fraud face both prison and huge civil penalties.
In announcing the convictions, Illinois State Police director Leo Schmitz said,
“Unfortunately this type of fraud is something we continue to see all too often. This critical program is for individuals or families who truly need the help, and Medicaid recipients will continue to suffer as a result of criminals who defraud the system. The ISP Medicaid Fraud Control Bureau will continue to aggressively investigate these cases and work with the Illinois Attorney General’s Office to ensure the people who commit these crimes are prosecuted.”
ISP Captain Brian Ley commented, “It’s troubling when people steal from a program designed to assist individuals with limited resources. When you’re committing Medicaid fraud, you’re not only stealing from the government, you’re stealing from those most in need.”
Illinois Pays Cash Awards to Those Who Report Healthcare Fraud
Illinois residents are fortunate to have three healthcare whistleblower statutes that pay cash awards to those with inside information about healthcare fraud.
The federal False Claims Act pays awards of up to 30% from whatever the government collects from wrongdoers. Under the federal law, rewards are available for those with information about federally funded healthcare programs including Medicare, Tricare, VA healthcare and the federal matching funds for Medicaid.
The Illinois Whistleblower Award and Protection Act pays awards for inside information about state funded Medicaid.
A third program, one of only two in the nation, pays for inside information about fraud involving private funded healthcare. The Illinois Insurance Fraud Prevention Act pays awards for fraud involving Blue Cross, Aetna, United HealthOne, Humana and any other private insurance program in the state.
In all three programs, awards are payable from the amounts collected from the wrongdoers. Because these laws often carry triple damages and high fines, awards can add up quickly.
If you know of healthcare companies cheating on their billing or services involving Medicare or Medicaid, you may be eligible for a reward. Reporting fraud is not only the right thing to do, it also saves taxpayers money and protects patients.
Call 888.742.7248 or Report Online & Check Reward Eligibility