Your affiant, Angie Weidemann, is an investigator with the Medicaid Fraud Control Unit (“MFCU”) of the Minnesota Attorney General’s Office. As an investigator for the MFCU, I investigate allegations of billing fraud by health care providers enrolled in the Minnesota Medical Assistance Program (“Medicaid”). The MFCU investigated Ahmed Mohammed Alsaid Agwa [DOB REDACTED] (“AGWA”), Defendant herein, and determined that AGWA defrauded the Medicaid program by submitting claims for Personal Care Assistant (“PCA”) services that he did not provide.
I determined that AGWA could not have provided these services because he claimed to have provided services when a recipient was traveling and out of the state or country, or when AGWA was traveling and out of the state or country. AGWA’s false representations caused the Medicaid program to overpay $94,696.61, of which AGWA received $59,712.96. I. The Medicaid Program The Medicaid program provides medical care and services to low-income Minnesotans (“recipients”) who meet certain income and other eligibility requirements.
The Minnesota Department of Human Services (“DHS”), located in St. Paul, administers the Medicaid program. DHS contracts with or enrolls Personal Care Assistance Provider Agencies (“Agencies”) to furnish health care services to Medicaid recipients. Agencies that contract with DHS submit claims directly to DHS to receive reimbursement for services. Under Medicaid guidelines, Personal Care Assistant (“PCA”) services are provided by a PCA who is employed by an Agency to provide personal care to a recipient.
PCA services include assistance with activities of daily living (“ADL”) like dressing, grooming, bathing, eating, mobility, and toileting. PCA services also include instrumental activities of daily living (“IADL”) such a shopping, paying bills, and meal preparation. PCA services occur in a recipient’s home or in the community where normal daily activities take place. PCA services may be provided outside of Minnesota within the United States if they meet specific requirements and inform the Agency of wanting to use PCA services outside of Minnesota before they leave the state.
A recipient may not use PCA services outside of the United States. Agencies must submit background study requests, enrollment applications, and provider agreements for each of their PCAs before they provide services to recipients. Both the PCA and the recipient are required to accurately document the time the PCA spends with a recipient on a timesheet and sign the timesheet to verify that services were provided. Timesheets must also include the services provided in the recipient’s home, any time spent traveling, or any time a recipient is hospitalized, in a care facility, or incarcerated.
The PCA then submits the timesheet to the Agency, which bills DHS for PCA services based on the information reported in the timesheet. II. Defendant’s Fraudulent PCA Services Following an initial investigation into Shawki Mohamed Hamed Elsaid [DOB REDACTED], Co- Defendant herein, MFCU investigated AGWA’s provision of PCA services and determined that AGWA had submitted claims for services that he could not have provided. AGWA worked for Pride N Living Home Care, Inc. (Pride N Living), a Minnesota corporation with a principal place of business in Anoka County.
