Illinois State Police, Medicaid Fraud Control Bureau investigation leads to vendor fraud convictions

SPRINGFIELD –The Illinois State Police (ISP) announce the sentencing of a former personal assistant and the Medicaid recipient.  On June 24, 2016, Misty Atwood, age 41 of Roodhouse, pled guilty to one count of Vendor Fraud, a class 1 felony in Greene County.  On September 29, 2016, Alfred Holder, age 65 of Roodhouse, pled guilty to one count of Vendor Fraud, a class 1 felony in Greene County.

On June 17, 2015, the ISP, Medicaid Fraud Control Bureau (MFCB) received a complaint from the Illinois Department of Healthcare and Family Services, Office of Inspector General, regarding alleged Medicaid fraud.  The ISP MFCB and the United States Department of Health and Human Services, Office of Inspector General (HHS/OIG) conducted an investigation and determined Atwood and Holder defrauded the Medicaid program out of $28,197.  The investigation revealed Atwood submitted fraudulent documents to the Illinois Department of Human Services (IDHS), Division of Rehabilitation Services for payment for providing personal care services to Holder.  ISP MFCB and HHS/OIG agents discovered Atwood and Holder conspired to falsify the documents provided to IDHS for payment which they shared.    

“It’s troubling when individuals steal money from a program designed to assist people with limited resources,” stated Director Leo P. Schmitz. “It is not often we investigate the Medicaid recipient, but when they work in conjunction with caregivers to defraud the people of Illinois, we're going to hold the recipient accountable as well,” he continued.

This conviction comes on the heels of the state of Illinois ramping up efforts against health care based fraud. In April, Governor Rauner signed Executive Order 16-05, creating the Health Care Fraud Elimination Task Force. This Task Force will study and utilize the best practices of agency fraud prevention units, including MFCB, the efforts of the federal government and other state governments, and those in the private sector to root out fraud, waste, and abuse. The Commander of the ISP MFCB, Captain Brian Ley, serves as a member of the Governor's Task Force.

Once investigated, the case was referred to the Attorney General’s Medicaid Fraud Bureau for prosecution.

"Personal care services are among the most critical services the state provides, and my office is committed to prosecuting individuals who use these funds for personal gain," Attorney General Lisa Madigan said.

Atwood and Holder were both sentenced to four years of Felony Probation and ordered to pay $13,614.44 in restitution to IDHS."    

Individuals are encouraged to call the ISP Medicaid Fraud Hotline at (888) 557-9503 to report suspected fraud of medical providers involved the Medicaid system.