Your affiant, Sergio Fernandez, 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”). In this capacity, I investigated Tiaesha Lashae Ellis [DOB REDACTED] (“ELLIS”), Defendant herein, and determined that ELLIS defrauded the Medicaid program by submitting claims for Personal Care Assistant (“PCA”) and homemaker services that she did not provide.
I determined that ELLIS could not have provided these services because her employment records documented overlapping hours between recipients, her employment records documented overlapping hours with her third-party employer, or she claimed to have provided services when a recipient was not available to receive services or when she was not available to provide services. ELLIS’s false representations caused the Medicaid program to overpay $62,600.85, of which ELLIS received $40,092.09. 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 like dressing, grooming, bathing, eating, mobility, and toileting. PCA services occur in a recipient’s home. Agencies must submit background study requests, enrollment applications, and provider agreements for each of their PCAs before they provide services to recipients. DHS also contracts with health care providers that provide Home and Community-Based Services (“HCBS”), also sometimes referred to as 245D services or waivered services, for Medicaid recipients.
HCBS services are provided to persons with disabilities and the elderly who are eligible to receive the services and are individually assessed to require the services. HCBS services include, but are not limited to, homemaker services. Homemaker services involve home management and cleaning needs provided by an individual in the recipient’s own home. Medicaid also offers a shared care option for recipients of PCA services. Shared care services are provided in the same setting at the same time by the same PCA for multiple recipients.
