Springfield, IL –The Illinois State Police (ISP) and the Illinois Office of the Attorney General announce the conviction and sentencing of four Personal Assistants (PA) and one Home Services Program Customer as a result of three separate investigations.
On October 2, 2013, the ISP Medicaid Fraud Control Bureau (MFCB) began an investigation involving defendant Cynthia Evans of Rockford, Illinois, for fraud related to the Illinois Department of Human Services (DHS) Home Services Program (HSP). Evans was a Personal Assistant for an HSP program recipient in Genoa, Illinois. Evans started working as a PA in December 2012, but stopped providing services in April, 2013. The investigation revealed Evans continued to receive payments by signing and submitting time sheets to DHS through February 2014, even though she was no longer providing services.
On July 19, 2017, Cynthia Evans entered a guilty plea in Dekalb County to one count of Vendor Fraud (class 2 felony) and was sentenced to a period of probation of 24 months and was ordered to pay restitution in the amount of $8,469.
On April 23, 2013, the ISP MFCB began an investigation in Rockford, Illinois, alleging fraudulent DHS HSP time sheets were being submitted by Personal Assistant Judy Melchor of Freeport, Illinois. The investigation revealed time sheets were submitted while program recipient Kattie Sanders was not at home and either a hospital patient, in a nursing home, or incarcerated in the Winnebago County Jail. The fraudulent DHS time sheets were submitted from May 16, 2010, through June 30, 2012. The investigation also discovered Melchor and Sanders were splitting the money Melchor received from DHS for services she never provided. The investigation also revealed Starvaiena Sanders, another PA to Kattie Sanders, admitted she provided fraudulent time sheets to DHS from July 16, 2012, through October 15, 2012.
On April 13, 2017, Kattie Sanders entered a guilty plea to one count of Vendor Fraud (class 1 felony); on May 17, 2016, Starvaiena Sanders entered a guilty plea to one count of Vendor Fraud (class 3 felony); and on July 7, 2017, Judy Melchor entered a guilty plea to one count of Vendor Fraud (class 1 felony). All three pleas occurred in Winnebago County.
Judy Melchor and Kattie Sanders were both sentenced to a period of probation of 48 months and were ordered to pay a shared restitution in the amount of $41,638. They were also ordered to complete 200 hours of community service and will serve 180 days in jail if they fail to pay the restitution. Starvaiena Sanders was sentenced to 24 months of probation and was ordered to pay restitution in the amount of $1,747.
Kattie Sanders Judy Melchor Starvaiena Sanders
On June 5, 2015, the ISP, MFCB began an investigation involving an allegation of Vendor Fraud. Personal Assistant Lisa Opinga of Rockford, Illinois, was suspected to have turned in time sheets and billed DHS for work she did not perform for a program recipient who was living in the Philippines. The investigation revealed that during her time as a PA, Opinga submitted time sheets which indicated she provided home services in Rockford, Illinois from April 2014 through June 2015 while the recipient was actually out of the country.
On June 7, 2017, Lisa Opinga entered a guilty plea to one count of Vendor Fraud (class 3 felony) in Winnebago County. Opinga was sentenced to 24 months of probation and ordered to pay restitution in the amount of $4,723.
“Unfortunately this type of fraud is something we continue to see all too often,” stated ISP Director Leo P. Schmitz. He continued, “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.”
“It’s troubling when people steal from a program designed to assist individuals with limited resources,” stated Captain Brian Ley, Commander of the ISP, MFCB. “When you’re committing Medicaid fraud, you’re not only stealing from the government, you’re stealing from those most in need. We will continue to investigate cases of provider fraud within the Medicaid program,” he continued. Captain Ley serves as a member of Governor Rauner's Health Care Fraud Elimination Task Force. The task force was created in April of 2016, to look strategically and comprehensively into fraud, waste, and abuse in taxpayer funded health care systems.
Once investigated, all three cases were referred to the Attorney General’s Medicaid Fraud Bureau for prosecution.
“Personal assistants provide essential services that allow some of the state’s most vulnerable residents to live and be cared for in their homes,” Attorney General Lisa Madigan said. “We will continue to aggressively pursue defendants who take advantage of this critical program and ensure they are held accountable.”
Individuals are encouraged to call the ISP Medicaid Fraud Hotline at (888) 557-9503 to report suspected fraud of medical providers involved in the Medicaid system.