Your affiant, Angie Weidemann, is the Supervising Investigator with the Medicaid Fraud Control Unit (MFCU) of the Minnesota Attorney General’s Office. As the Supervising Investigator in the MFCU, I supervise investigators and investigate allegations of billing fraud by health care providers enrolled in the Minnesota Medical Assistance Program (Medicaid). In this capacity, I supervised the investigation of and investigated Nadia Hassan [DOB REDACTED] (HASSAN), Defendant herein, and determined that HASSAN defrauded the Medicaid program by submitting claims for Personal Care Assistance services (PCA services) that she did not provide.
I determined that HASSAN could not have provided these services because the times she purported to provide them overlapped with times she purported to provide services to other recipients or worked at other employment. As a result of these false claims, the Minnesota Department of Human Services paid out $5,413.47 in Medicaid funds, of which $3,937.44 HASSAN received in wages. I. THE MEDICAID PROGRAM The Medicaid program provides medical care and services to Minnesotans who meet income and other eligibility requirements (recipients). The Minnesota Department of Human Services (DHS) administers the Medicaid program.
Health care providers wishing to furnish health care services and goods to recipients must enroll in the Medicaid program by entering into an agreement with DHS, which is in Saint Paul, Minnesota. Providers may then submit claims directly to DHS to receive reimbursement for their services under an arrangement known as fee for service. Providers are informed of the rules and regulations governing participation in the Medicaid program through the Minnesota Health Care Programs Provider Manual. For instance, providers must submit claims only after services are rendered and cannot submit claims that overstate either the level or the amount of care provided Medicaid covers PCA services, which include assistance with activities of daily living such as dressing, grooming, bathing, eating, mobility, and toileting.
To qualify for PCA services, a recipient must undergo an assessment by a county public health nurse whose role is to determine the need for services, identify appropriate services, evaluate the effectiveness of services, and provide information on different PCA service options. A recipient who qualifies for PCA services may hire a PCA provider agency to furnish those services. The PCA provider agency acts as an intermediary between the recipient and DHS. The PCA provider agency contracts with DHS to provide services to the recipient and hires individual personal care assistants (PCAs) to provide services in the home of the recipient.
Minnesota law requires that PCAs document their work on timesheets. Documentation requirements include the date of service, the PCA’s name, the recipient’s name, the PCA’s arrival and departure times (including A.M. And P.M. Designations), the total number of hours worked each day, and a description of the services provided. Both the PCA and the recipient must sign the timesheets to verify the hours of service. The timesheets are submitted to the PCA provider agency, and the PCA is paid wages based on the hours documented on the submitted timesheets.
