18 Charged In $9.5M Minnesota Medicaid Fraud Scheme: AG

MINNEAPOLIS — Eighteen people have been charged so far in a scheme to defraud the Minnesota Medical Assistance (Medicaid) program out of approximately $9.5 million, Minnesota Attorney General Keith Ellison announced Tuesday.

The charges — filed against the owners and employees of the now-defunct personal care assistant (PCA) service agency "MN Professional" — mark the largest Medicaid fraud prosecution in Minnesota.

The owners, managers, and a biller at MN Professional face the most serious charges. They were identified as Abdikarim Mohamed, Ahmed Nur, Abubakar Ahmed, Ali Elmi, Omar Dirie and each face one count of racketeering, one count of engaging in business of concealing criminal proceeds, and eleven counts of aiding and abetting theft by swindle (over $35,000).

More people are expected to be charged as the investigation continues, according to Ellison's office.

"Minnesotans who receive Medical Assistance have a right to expect they’ll receive all the care, dignity, and respect they’re entitled to," Ellison said in a statement.

"Minnesotans trying to afford their lives have a right to expect that every one of their tax dollars will be spent properly and legally. People who commit Medicaid fraud violate both of those rights. My office is working aggressively to hold these and all offenders accountable — and we will keep doing so."

Allegation 1: Billing Medicaid for services not provided

According to the investigation, MN Professional fraudulently billed the Medicaid program for more than 25,000 hours of services that were never actually provided.

The fraud was committed without the knowledge of the PCAs themselves, investigators said.

In interviews, PCAs regularly stated that they did not provide services to recipients that were billed under their name and provider number, according to authorities.

MN Professional received more than $1.6 million for services billed but not provided.

Allegation 2: Billing Medicaid for PCA services that were not supervised by a nurse

Minnesota law requires that PCA services be supervised in regular intervals by a registered nurse or other certified medical professional. However, investigators found that MN Professional clients went years without any supervision by a certified medical professional, authorities said.

MN Professional received more than $7.8 million in Medicaid funds for the unsupervised PCA services of at least 120 clients, according to investigators.