Missouri Woman Sentenced For Health Care Fraud

Follow @SDILNews

Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced that today, Tisa V. Vaughn, 49, of Florissant, Missouri, was sentenced on a one-count indictment charging that she engaged in a scheme to commit health care fraud. On March 19, 2014, a jury found Vaughn guilty after a three-day trial in federal court. Today, the district court sentenced Vaughn to fifteen months in federal prison, to be followed by three years of supervised release. Vaughn was also ordered to pay $14,873.56 in restitution back to the State of Illinois and a $100 special assessment.

Evidence showed that Vaughn was the personal assistant for her sister, a Medicaid recipient, who resides in East St. Louis. It was shown at trial that Vaughn billed for hours of care when she was either not caring for her sister or when her sister was actually in the hospital. Furthermore, testimony indicated that the sisters split the payments that Vaughn billed and received from the Home Services Program for the State of Illinois. In today’s sentencing, the district court commented that the sentence was higher than usual because Vaughn had obstructed justice by having her sister lie about the fraud scheme to authorities.

“Nationwide, the biggest fraud problem in the Medicaid program has been these personal assistant programs which represent the number one fraud complaint to state Medicaid fraud units. Especially vulnerable to fraud are programs, such as the one implemented in Illinois, which allow the Medicaid recipient to control the selection and payment of personal care attendants. In most cases, the personal care assistant is a relative or family friend, who often is a ghost employee. In a typical fraud scenario, the scam payments made by the State of Illinois are split between the Medicaid recipient and the ghost employee. The terrible effect of this fraud is that it draws much-needed funds away from those who are truly deserving. It is for that reason that my office will continue to try to root out and prosecute these offenders. Unless you want to be a convicted felon, my advice is, simply, do not steal.” said United States Attorney Wigginton.

The investigation was conducted by the U.S. Department of Health and Human Services Office of Inspector General and the Illinois State Police - Medicaid Fraud Control Bureau. The case was prosecuted by Assistant United States Attorneys Michael J. Quinley and Liam Coonan.