FWA (MN)- Charges filed against 18 people in alleged $9.5 million Medicaid caregiver fraud case

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[MM Curator Summary]: Pretty big for a personal care assistant scheme.



Clipped from: https://kstp.com/kstp-news/local-news/charges-filed-against-18-people-in-alleged-9-5-million-medicaid-caregiver-fraud-case/

Owners and managers of a personal care assistant (PCA) company are facing criminal charges related to a scheme to defraud the Minnesota Medical Assitance Program (Medicaid) out of about $9.5 million.

The case is the largest Medicaid fraud prosecution charged by the Minnesota Attorney General’s Office and its Minnesota Medicaid Fraud Control Unit, the attorney’s office says.

Court documents show the owners of the company called MN Professional — 58-year-old Abdikarimm Mohamed and 53-year-old Ahmed Nur — are each charged with one count of racketeering, one count of engaging in the business of concealing criminal proceeds and 11 counts of aiding and abetting theft by swindle of an amount larger than $35,000. Three managers in the company, 55-year-old Abubakar Ahmed, 60-year-old Ali Elmi and 44-year-old Omar Dirie, are charged with the same crimes.

Prosecutors say that the company billed Medicaid for services that were not provided, which amounted to more than $1.6 million. MN Professional also allegedly provided services without a nurse or qualified professional (QP) present for at least 120 clients, which added up to more than $7.8 million. Minnesota law mandates that PCA services must be supervised by a QP in order to be eligible for payment from Medicaid.

“Minnesotans who receive Medical Assistance have a right to expect they’ll receive all the care, dignity, and respect they’re entitled to,” Minnesota Attorney General Keith Ellison said in a prepared statement. “Minnesotans trying to afford their lives have a right to expect that every one of their tax dollars will be spent properly and legally. People who commit Medicaid fraud violate both of those rights. My office is working aggressively to hold these and all offenders accountable — and we will keep doing so.”

As of Wednesday afternoon, a total of 18 people are charged with crimes revealed in the state’s investigation, including recruiters, an office manager and PCAs. Those charges include 32 counts of aiding and abetting portions of the agency’s fraud and one count of identity theft. There were also six other people who were previously charged and all but one of them pleaded guilty according to a news release from the AG’s office.

RELATED: 4 charged with defrauding Medicaid program of over $900K

The complaint states that the crimes were concealed through “an elaborate cash-checking scheme.” The checks were apparently written in the names of PCAs whose identities were used to bill fraudulently, and the suspects kept the cash for themselves. This caused some PCAs to get artificially inflated W2s that showed they received wages from MN Professional that they did not.

Prosecutors say Mohamed and Nur both fraudulently listed their wives as board members and consultants at the company and paid them hundreds of thousands of dollars under the guise of paying their salaries.

The suspects are also accused of recruiting clients and PCAs with the intent of using them to defraud the Medicaid program and falsify information to get loans related to COVID-19 relief.

The AG’s office says more charges are expected to be filed against others as the investigation continues.