Civil servant works quietly

Michele Fox doesn't look like she could send your company's stock prices plummeting.

In fact, the Algonquin grandmother of two insists she's rather boring. Her only hobby is gardening, she explains apologetically to a reporter.

But it's pretty certain Amerigroup, a national insurance company, doesn't consider Fox, an assistant U.S. Attorney, boring. Terrifying, maybe -- but not boring.

"Defendants can underestimate her at their peril," said Michael Behn, an attorney who worked on the case with her.

Fox, 58, was part of one of three legal teams that convinced a jury last year to find Amerigroup Illinois had submitted more than 18,000 false Medicaid claims that defrauded both Illinois and the U.S. government.

With the triple damages and civil penalties the law allows, the verdict came to $334 million dollars -- the largest verdict ever awarded for a federal false acts claim, the U.S. Attorney's Office said.

The day of the verdict, Amerigroup's stock dipped 15 percent, and the company has left Illinois -- although it claims its departure was unrelated

Fox and her co-counsel Assistant U.S. Attorney Samuel B. Cole -- a Palatine native who now lives in Deerfield -- were recently recognized Oct. 2 in Washington, D.C., for the verdict.

The attention is somewhat new for Fox, who co-workers say has quietly worked away since 1989 on the less glamorous side of the U.S. Attorney's Office -- the civil law side -- while criminal prosecutors grab most of the headlines by convicting ex-governors and mobsters.

How Fox has now come into the limelight is a story that started on the Northwest Side of Chicago where her homemaker mother and Butternut bread truck driver father sent her to grade school at St. Tarcissus and Imaculata High School. From there, it was off to Loyola for undergrad, where she met her husband Robert Fox.

The two moved to Algonquin in 1973, in part, to stay close to her parents who had also moved there.

"When we moved in, Algonquin was a burg of about 3,000 people," she recalled. "Randall Road was two lanes with stop signs."

"I thought it was a good choice for the family," she said. "It still is. It's a good community to live in."

Fox began to raise a family while working for the Social Security Administration, the Department of Labor and OSHA.

She and Robert had a son, also named Robert. When Robert was 4, Fox not only kept working, but started night school at John Marshall Law School before transferring to DePaul.

"Without my family support, I never would have pulled it off," she said, recalling the long commutes and fervent studying during lunch hours.

Fox picked law because, even though women were not yet ubiquitous in the field, it was one of the few that were starting to diversify.

"Back in the '70s, women didn't work construction jobs," said Fox. "Law was an avenue that was opening."

In 1989 she joined the U.S. Attorney's Office. Among the cases she began working on were qui tam or "whistleblower" lawsuits.

In a qui tam case, an employee who knows a company is fraudulently billing the government can sue the company on the government's behalf. The suit is filed secretly and the U.S. Attorney's Office reviews the case to see if it wants to join in the suit. If the employee wins, he or she shares in the award.

In the Amerigroup case, Cleveland Tyson of Buffalo Grove, a former officer of Amerigroup, filed the suit in 2002 without a lawyer. Both the U.S. Attorney's Office and the Illinois Attorney General initially took a pass.

But Tyson eventually found a lawyer -- Behn -- and unearthed solid evidence that got both offices interested.

"Michele was involved in the key decision to get back in the case," recalled Behn. "It took real courage to reassess the case."

In Amerigroup's case, it had been hired to enroll Medicaid-eligible patients in government-funded HMOs. Patients could either elect to stay with Medicaid, or switch to the HMO.

Tyson and the government alleged that Amerigroup fraudulently steered pregnant women and high-cost patients away from their HMO so as to maximize profits -- even though their reimbursement rate had been calculated to include those high-cost cases, Fox said.

In a 2001 e-mail an Amerigroup executive wrote to managers, "Please keep up the good work with the marketing reps of not trying to sign up pregnant women."

The company's assurance to Illinois officials that they were signing up patients without regard to health condition or cost constituted fraud, the suit alleged.

Amerigroup, for the record, claimed that Illinois regulators were well aware of their selection process and approved of it. They are appealing the jury's decision.

Fox said the case illustrates why she got into government in the first place.

"I think government is a place to do something positive," she said. "There's a chance to influence things for the better."

Medicaid is a good program, and enforcing honesty in regards to it allows it to continue, she said. Unfortunately, because the health care field involves so much money, there is a tremendous temptation to try to defraud.

Qui tam cases recovered $15 billion for taxpayers from 1987 to 2005, with whistleblowers taking about $1.6 billion of that amount.

About 33 percent of those cases were health care fraud cases, according to a Government Accountability Office study.

"From my point of view … part of pursuing a career in government is trying to ensure that the good programs … they're able to be implemented the way they were intended," said Fox.

Behn puts it a little more directly. He says Fox is "recover(ing) the taxpayers' money from liars, cheats and thieves."

"She's the kind of person who every taxpayer and citizen should be very happy to have representing them in court," Behn said.