Your affiant, Meaghan Moen, 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 (Medicaid) Program. In this capacity, I investigated ASHREEN (no middle name) MURSALIM [DOB REDACTED] (MURSALIM) the defendant herein, and determined that MURSALIM defrauded the Medicaid program by getting paid for personal care assistant (PCA) services and waivered services that she did not provide.
As a result of these false claims, UCare paid out $4,269.73 in Medicaid funds, $2,555.87 of which MURSALIM 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 Medicaid program is administered by the DHS. The DHS contracts with or enrolls providers to furnish health care services and goods to Medicaid recipients, some of whom receive their services on a managed care basis through one of Minnesota’s managed care organizations (MCO) like UCare.
Health care providers wishing to furnish health care services to recipients must enroll in the Medicaid program by entering into an agreement. Providers then submit claims directly to DHS or the MCO, which then reimburses the provider in Medicaid funds. Under Medicaid guidelines, personal care services are provided by a personal care assistant (PCA) who is employed by a Personal Care Assistance Services Agency (Agency) for the purpose of providing personal care necessary to maintain a recipient in his or her residence.
A PCA is required to accurately document the time he or she spends with a recipient on a timesheet. The PCA then submits the timesheets to the Agency, which bills the DHS or MCO for PCA services based on the information reported in the timesheet. DHS or the MCO reimburse the agency, and the agency pays the PCA. Medicaid covers PCA services, which include assistance with activities of daily living like dressing, grooming, bathing, eating, mobility, and toileting. Unless certain limited exceptions apply, PCA services occur in a recipient’s home and are documented on a timesheet.
Medicaid recipients may choose to receive shared PCA services, or services provided to up to three recipients at the same time in the same location by one PCA. To receive shared PCA services, the recipient must advise the county assessor that the recipient wishes to use the shared care option and sign a Home Care Shared Services Agreement agreeing to, among other things, document on a daily basis, the start and end times of the shared service, the location of the shared service, and any notes regarding changes in condition or problems as a result of the shared service.
