Safeguarding Your Services Preventing Medicaid Fraud - DHS 4251

State of Illinois
Department of Human Services

4251 (pdf)

Safeguarding Your Services - Preventing Medicaid Fraud

"If you permit it, you promote it"

What is the Home Services Program (HSP) Fraud Unit?

The HSP Fraud Unit is the delegated authority that conducts investigations related to allegations of fraud within the HSP program.

Does a Customer have to repay any misused funds?

  • YES;
  • The Fraud Unit works with DHS Bureau of Collections to set up repayment agreements;
  • The Fraud Unit works closely with the Department of Healthcare & Family Services (HFS) - Office of Inspector General (OIG); and
  • If charged criminally by the Illinois State Police (ISP) or the Federal Bureau of Investigation (FBI), an individual may go to prison, do probation or community service and be ordered to pay restitution.

Note: Fraudulent practices may result in the changing of the IP to a homemaker agency, termination of HSP services and/or prosecution.

Rights and Responsibilities of a Customer

The Customer is the employer. This means that as a Customer you are responsible to hire and manage your own Individual Providers (IPs).

The Customer has the responsibility to:

  1. Ensure your IP has completed and submitted all paperwork and received their Santrax ID before they begin working for you;
  2. Ensure your IP is appropriately using the EVV system and calling in and out each time they provide services to you;
  3. Monitor your IP's hours to ensure the provider is only working the approved hours and tasks indicated on your service plan;
  4. Ensure you have a back-up provider for instances where your IP is sick or not able to come to work;
  5. Follow DRS policy and procedures (Example: spouses are not allowed to be hired as an individual provider);
  6. Report all changes to your HSP counselor; this includes any times you are hospitalized or away from your home. This also includes a change of address, phone number or service needs;
  7. Work together with service providers, DHS staff, and representatives to comply with HSP service plans, reassessments of eligibility and other administrative rules;
  8. Sign all forms which are required under
    • federal or state law;
    • federal or state rule;
    • the Medicaid Waiver; or
    • are necessary to process payment through the Comptroller's Office.
  9. Report any fraudulent activities you are aware of; and
  10. Thoroughly review the time sheet before signing it to ensure all information is complete and correct. This includes reviewing the specific days/hours listed that the IP provided care according to the HSP Service Plan, as well as verifying that the listed addresses and telephone numbers are correct and current.

The Customer has the right to:

  1. Speak to your HSP counselor for help with problems/issues regarding your care;
  2. Terminate an IP that is not performing the duties he/she was hired to provide;
  3. File a report with Adult Protective Services (APS) for neglect/abuse;
  4. Request homemaker services if you are not able to manage your IP; and
  5. Cancel your case at any time.

What is Fraud?

Fraud is a dishonest and deliberate misuse of State or Federal funds, and the intentional misleading or deceitful conduct that deprives the State of its resources or rights.

Fraud is further defined as:

  • The act of deceiving or misrepresenting; and
  • The act of using dishonest methods to take something valuable from an individual.

Why Report Medicaid Fraud?

  • Medicaid fraud should be reported because Medicaid payments are made from federal and state funds supplied by taxpayers; and 
  • When Medicaid funds are stolen through fraud, that money is no longer available tohelp deserving customers.

Examples of Fraud:

  • Submitting a time sheet with days and/or hours that the worker did not work;
  • The Customer requesting the IP to perform duties not authorized on the Service Plan;
  • The Customer signing the time sheet before all services have been completed for the pay period;
  • The customer demanding the IP split their check with them;
  • Calling in and out for your IP with the use of the EVV system; and
  • Fraudulently requesting HSP services for an unwarranted disability.

Important Phone Numbers

EVV Call in/Call out

English

(855)347-1770

(855)573-0726

Spanish

(855)347-0771

(855)573-1726

Abuse/Neglect Hotline

Adult Protective Services

(866)800-1409

Home Services Program Helpline

(888)713-5139

(866) 324-5553 TTY/Nextalk or 711 TTY Relay

Programs, activities and employment opportunities in the Illinois Department of Human Services are open and accessible to any individual or group without regard to age, sex, race, sexual orientation, disability, ethnic origin or religion. The department is an equal opportunity employer and practices affirmative action and reasonable accommodation programs.  DHS 4251 (N-05-17) Safeguarding Your Services  Printed by the Authority of the State of Illinois.  P.O.#17-1840 50,000 copies