Your affiant, Sarah Levine, is a Lead Investigator with the Medicaid Fraud Control Unit (MFCU) of the Minnesota Attorney General’s Office. As a Lead Investigator for the MFCU, I investigate allegations of billing fraud by health care agencies and providers enrolled in the Minnesota Medical Assistance (Medicaid) program. In this capacity, I investigated Guardian Home Health Services, Inc. (Guardian), owned by Mohamed Abdirashid Omarxeyd (OMARXEYD). OMARXEYD owned Guardian, a Medicaid- enrolled home health care agency.
Through Guardian, OMARXEYD defrauded the Medicaid program by submitting claims for PCA and Waivered services that were either not provided at all or not provided in accordance with the law. Based on these fraudulent claims, OMARXEYD through Guardian unlawfully received $3,213,658.47 in Medicaid funds. I. THE MEDICAID PROGRAM The Medicaid program provides medical care and services to Minnesotans who meet certain income and other eligibility requirements (recipients). The Medicaid program, known in Minnesota as medical assistance, is administered by the Minnesota Department of Human Services (DHS). The DHS enrolls health care providers by entering into an agreement to furnish health care services and goods to Medicaid recipients.
Medicaid providers are informed of the laws and regulations governing their participation through the Minnesota Health Care Programs (MHCP) Provider Manual (Manual), which provides specific information for each provider type. For instance, providers must submit claims only after services are rendered and cannot submit claims that overstate either the level of care provided, or the amount of care provided. The Manual informs providers of criminal penalties for: (1) making a statement known to be false in an application for payment or for use in determining rights to such payment; (2) failing to disclose a fact affecting the vendor’s initial or continuing right to receive payments with the intent to wrongfully obtain such payments; and (3) making a statement known to be false so that facility may qualify, or continue to qualify, as a home health agency.
The Manual is available to providers electronically, and updates occur on a continuous basis. The DHS also issues bulletins to clarify existing laws and regulations and to summarize any changes. The DHS further explains MHCP laws and regulations during a three-day training program called “Steps for Success.” PCA services agency owners, managing employees, and qualified professionals must attend Steps for Success before enrolling in the MHCP. Finally, the DHS offers a “PCA Billing Lab” which teaches PCA services agencies how to properly bill claims to the DHS. As a condition of their enrollment in the MHCP, providers agree to comply with all rules relating to the delivery of Medicaid services to their recipients and to the submission of claims for such services, including those rules set forth in the Manual.
