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January 11, 2016

MADIGAN: CHICAGO WOMAN CONVICTED OF MEDICAID FRAUD

Chicago — Attorney General Lisa Madigan today announced that a Chicago woman was sentenced to six years in the Illinois Department of Corrections for Medicaid fraud.

Debra Gaines, 55, of Chicago, was convicted of Theft of State Property, in this case Medicaid funds, and Vendor Fraud in July 2015 by Judge James Linn in Cook County Circuit Court. On January 4, 2016, the court sentenced her on class X Theft of State Property (Medicaid funds) in her scheme to collect Medicaid funds for mental health services that were falsely claimed to have been provided by a doctor. The other count of Vendor Fraud was merged with the count of Theft of State Property.

In the charges against Gaines, Madigan alleged that she billed Medicaid under her business named “Heavenly Interventions” in the amount of $276,000, falsely claiming that Dr. Ernest Mensah had provided services to Medicaid recipients on behalf of Heavenly Interventions between 2007 and 2010. Heavenly Interventions provided physiological services to Medicaid recipients that could only be provided by a physician and Medicaid provider. Dr. Mensah, a Medicaid provider, never provided services at Heavenly Interventions. Rather, Gaines used Dr. Mensah’s personal information, including his social security and medical license numbers that he provided when he inquired about a job at Heavenly Interventions, to create documents that made her the alternate payee for services rendered by Dr. Mensah.

“Medicaid fraud is a serious crime that exploits a system meant to provide needed services to vulnerable patients,” said Madigan. “We will take action to hold those who engage in Medicaid fraud accountable.”

Assistant Attorney Generals Rick Crystal and Rob Sparano handled the case for Madigan’s Medicaid Fraud Bureau.

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