The owners of a Brooklyn Park home health care company, Dependable, Inc., have been charged with Medical Assistance fraud after submitting false claims in excess of $300,000. The Department of Human Services (DHS) provider fraud unit received information about a personal care assistant (PCA) who was engaged in possible fraudulent activity. The department's Surveillance Integrity Review Section (SIRS) investigated the tip and discovered a number of billing problems including false documentation, incomplete care plans and missing documentation.
As a result of the SIRS investigation, the department withheld future payments to Dependable, owned by Sandra Bakare and her husband, Abimbola Bakare. The information was turned over to the state Attorney General's Minnesota Fraud Control Unit (MFCU) which conducted an additional investigation. An extensive review of records, timesheets and bills, in addition to interviews with Dependable staff, found that the Bakares submitted false claims for services provided between January 2010 and July 2013. This resulted in DHS overpaying Dependable $303,534 for PCA and qualified professional (QP) services that were never provided.
A Scott County woman who received public assistance for eight years after fraudulently reporting she had no income was sentenced to 180 days in jail, ordered to pay $186,783 in restitution and was sentenced to 10 years' probation in February 2015.
The conviction comes after an anonymous caller tipped off the Scott County fraud prevention investigator (FPI) who, together with the county Sheriff's Office, completed an investigation.
Nicole Robinson, also known as Nicole Johnson, applied for public assistance in 2003 claiming that she was a stay-at-home mother with three children and no income. But investigators uncovered that Robinson worked three jobs, had an alias name and a false social security number.
As a footnote to this, shortly after her conviction, Robinson was taken into custody by agents of the U.S. Department of Homeland Security for being unlawfully present in the U.S.
The fraud conviction is the result of assistance from a concerned citizen, skillful investigative work and collaboration between the Scott County FPI, the County Sheriff's Office and the County Attorney's office.
An Itasca County woman was convicted of aggravated forgery and theft by wrongfully obtaining assistance after claiming that a friend was caring for her children with disabilities. The woman was receiving child care assistance for having her children cared for in her home. The friend allegedly caring for the children was actually working full time in a different county.
At the time payments were being made, the child care assistance program allowed payments to be directly sent to the recipient if the children were being cared for in the home. Total payments in this case exceeded $25,000.
A fraud investigator received a tip from a neighboring county fraud investigator about the fraudulent child care claims. The investigator contacted the children's medical professionals and the school where forged doctor signatures and school documents were discovered.
With the assistance of the Itasca County attorney and the Sheriff's office, the woman who committed the fraud was sentenced to jail time and probation. She is required to pay restitution for the money she fraudulently obtained.
The owner of Comfort Home Health Services, LLC, was convicted of one count of Medical Assistance fraud and required to pay back $29,149 in restitution. Nick Choua Her, the owner of Comfort, a personal care provider organization, submitted bills for services that were not provided.
The DHS Office of Inspector General (OIG) began investigating the fraudulent billings and determined the provider received over $14,500 in overpayments based on claims submitted without the required documentation. With the finding, the OIG Surveillance and Integrity Review Section (SIRS) referred the case to the Minnesota Attorney General's Medicaid Fraud Control Unit (MFCU).
A MFCU investigator reviewed the DHS reports and documents and conducted a new investigation that revealed Her consistently billed for qualified professional and personal care assistant (PCA) services without supporting documentation. For example, the provider submitted claims for two hours of PCA services provided to the recipient each day from April 24 and June 9, 2012. However, no timesheets were available to support that the services were provided.
Her also submitted claims for 3-1/2 hours of PCA services over two days in January 2012. The investigation revealed that the PCA was arrested and jailed on one of those days.
In addition to owing $29,149 in restitution, Her was sentenced to 20 days in the Hennepin County Adult Corrections Facility, 80 hours of community service and three years of probation.
The Minnesota Department of Human Services (DHS) received information about suspected personal care assistant (PCA) fraud and followed up by conducting an onsite record review at Home Health Care, Inc. (HHC), a PCA agency. The review revealed that Antonina Demyanov signed timecards for a personal care assistant who not only wasn't coming to the home to provide services but was actually out of the country when the services were allegedly provided and billed. In addition, Demyanov submitted claims for approximately 12 months for PCA services to a minor child when the child was not at home but in an out-of-home placement.
The DHS Surveillance and Integrity Review Section (SIRS) identified and collected an overpayment of $122,049. Demyanov was charged with two counts of felony Theft by Swindle and three counts of felony Aggravated Forgery. On May 27, 2015, Demyanov pleaded guilty to one count of felony Theft by Swindle and was sentenced to restitution totaling $5,886, 30 days of electronic home monitoring and three years of probation. In addition, Demyanov cannot perform any work that involves Medicaid funding while she is on probation. Meanwhile, Demyanov's husband's case is pending.
The owner of a Minneapolis personal care provider agency was ordered to pay $8,180 in restitution after pleading guilty to theft by false representation in May 2015. Jama Hassan Khalif owned Decent Home Care, Inc. When a DHS investigator conducted a review of the organization's records, she determined that the provider billed DHS for personal care assistant and qualified professional services when there was no supporting documentation to indicate such services were provided.
The DHS investigator referred the case to the Minnesota Attorney General's Medicaid Fraud Control Unit which filed a criminal complaint against Decent Home Care, Inc. in Hennepin County District Court.
On May 18, 2015, Khalif entered into a plea of guilty. As part of the plea, the defendant agreed to a stay of adjudication which means the case would be dismissed after Khalif paid $8,180 in restitution. The restitution was received and DHS terminated the personal care provider agency effective July 28, 2015. In addition, Khalif can no longer own or be employed by any company that receives Medicaid or Medicare funds.