Neglected Because of Fraud

The Illinois Department of Human Services Home Services Program provides services to disabled beneficiaries so they can remain in their own homes, while living as independently as possible. The News-Democrat reports on an Illinois woman, who received Medicaid funds while caring for a family friend. Nothing seemed out of place until an investigation into the unfortunate death of the elderly woman revealed that the caretaker was responsible for criminal neglect.

The article states that a 62-year-old elderly woman died from a stroke, malnutrition and sepsis due to neglect. Court records showed that the deceased woman had lost more than half of her body weight within a month while under the care of her friend. (Some friend.)

It turns out that the 50-year old caretaker also housed a heroin addict, who would cash her Medicaid checks for a $40 cut per check. (Did I mention that the caretaker was an opportunist who made an extra $2,100 a month in disability payments and food stamps by letting the addict live in her house? Otherwise, she would have only made $900 a month.) When visited by the Department of Health and Human Services, the caretaker claimed the addict was her husband and the elderly woman’s brother. (Oh, what a tangled web she weaved.)

At sentencing, the defense attorney stated the caretaker had stage four kidney disease, and argued the defendant should only serve three years in prison, which would be the term recommended under the advisory sentencing guidelines. However, the judge rejected the recommended term in favor of a four-year term. (Way to go, Judge!) The defendant also was ordered to pay more than $78,000 in restitution for defrauding Medicaid. She is still facing state charges on two felony counts of criminal neglect of an elderly person resulting in death.

The article reports the heroin addict, who was sentenced to time served of six months, is now clean. He will have to pay nearly $21,000 in restitution.

One of the biggest nationwide problems within Medicaid has been fraud within the personal assistant program. Unfortunately, for the elderly person in this case – if the facts alleged are true – greed may have been instrumental in her death. Medicaid cannot afford to neglect the need for reform within a system that was designed to properly care for disabled citizens who depend upon state and federal agencies for their care. What changes would you recommend the Medicaid program make to prevent cases like this from happening in the future?

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