Home Health & Hospice Week

In one case, a criminal deposited fraudulent checks after pleading guilty.

If you’re wondering why states are cracking down on Medicaid fraud, look no further than a case in Minnesota.

Attorney General Keith Ellison has charged five persons linked to personal care assistant (PCA) services agency MN Professional with charges related to a $9.5 million fraud scheme, the AG says in a release. Owners Abdikarim Mohamed and Ahmed Nur, managers Abubakar Ahmed and Ali Elmi, and biller Omar Dirie conspired to bill for PCA services not provided and for PCA services not properly supervised, Ellison charges in a release.

They also concealed the fraud proceeds “through an elaborate check-cashing scheme” and caused artificially inflated W-2s for aides by issuing checks in the aides’ names that they actually cashed themselves. Plus, the owners “fraudulently listed their wives as ‘board members’ and ‘consultants’ at MN Professional and paid them hundreds of thousands of dollars in ‘salary,’” the AG says.

Six others were previously charged in the case, five of whom pleaded guilty, Ellison notes. Seven more have been charged recently, including recruiters, an office manager, and PCAs. “Additional charges are expected against other individuals as the investigation continues,” the release says.

“My office is working aggressively to hold these and all offenders accountable — and we will keep doing so,” AG Ellison says in the release.

Other state-level home care fraud cases include:

In Virginia: A woman who falsely claimed she was receiving Medicaid home care services has been sentenced to a whopping seven years in prison. From 2013 to 2021, Virginia Jackson-Wallace of Chesterfield claimed two family members were providing home health care to her and two other Medicaid recipients when, in fact, they were not, the Department of Justice says in a release. Jackson-Wallace submitted over 200 fraudulent timesheets for 22,938 hours of home health care not provided; opened joint bank accounts with the two purported aides but maintained exclusive control over the accounts; and even deposited two fraudulent checks and withdrew funds after pleading guilty in the case. The defendant had over 50 prior felony convictions, mostly related to a variety of fraud schemes, the DOJ adds.

In Iowa: A home care nurse is charged with billing for pediatric services she never provided and fabricating records to back up the fraudulent claims, the Iowa Capital Dispatch reports. In 2021 when employed by West Des Moines-based Iowa Home Care, Michelle Hayes forged 24 entries in her time sheets for 148 hours of service to a Medicaid patient at a cost of $7,364, according to the Dispatch. In August 2022, the licensing board charged Hayes with falsifying medical records and ordered her to pay a $500 fine and complete additional educational training in professional ethics and nurse advocacy, the newspaper says. Hayes has paid the fine and completed the training, so her license is “in good standing with the state,” but she still faces criminal charges in the matter, the newspaper says.

In Florida: Authorities have arrested Caridad Abreu Gonzalez on charges of Medicaid fraud. Abreu Gonzalez falsified time sheets and reported more than 800 hours of services never provided, causing more than $13,000 in overpayments, Florida Attorney General Ashley Moody says in a release.