A man from Christine, ND who had falsely claimed Minnesota residency and had been receiving public benefits from Minnesota since April 2011 was convicted of a felony in August 2016. Clay County Social Services received a call about Loren Willits’ receipt of Minnesota benefits over a four-year timeframe. The county fraud investigator followed up at the residence in Minnesota where Willits claim to have been living only to learn that he had never taken up residence there.
In addition to being charged with a felony, Willits will be required to pay restitution of $76,659 in addition to court fees. He is also serving probation for five years.
A Winnebago woman who was receiving public assistance was convicted of a felony last November for not reporting money she was receiving from her mother on an ongoing basis. Faribault County employees became suspicious when, following her mother’s death, Heather Hernandez applied for a county burial for her mother. In reviewing the decedent’s bank statements, employees noticed spending patterns that seemed unusual for a senior living alone.
Employees contacted the county fraud investigator who reviewed with Hernandez her mother’s finances. Hernandez initially denied getting money from her mother but later admitted receiving money while on public assistance when confronted with copies of checks and check activity.
Neither Hernandez nor her husband reported the money they received from Heather’s mother when they applied for public assistance benefits. Household overpayments totaled $8,792 from December 2012 through April 2013.
Hernandez was ordered to pay restitution of $8,792, complete 80 hours of community service and serve five years of probation.
A former Department of Revenue (DOR) employee pled guilty to a felony charge of Theft by False Representation in Hennepin County District Court and was sentenced on April 11, 2016. Osman Mohamed Farah, Minneapolis, was originally charged with six felony counts relating to theft of Medicaid funds.
Farah was working as an auditor when his supervisors discovered on his work computer what appeared to be Department of Human Services (DHS) forms relating to patient care. Department of Revenue officials referred the case to DHS Surveillance and Integrity Review Section (SIRS) of the Office of Inspector General.
DHS investigated and found that the notes in Farah’s work computer were progress notes for clients of a mental health program available through the Somali Family Youth Services. DHS also determined that the billings were submitted to DHS by the Associated Clinic of Psychology as the result of a contractual relationship between the clinic and the Somali Family and Youth Services. The alleged services provided by Farah were billed to DHS and UCare.
This case was a joint investigation by DHS and UCare. Investigators found that Farah’s services for program visits overlapped with his work day at Revenue. This occurred in 90 separate incidents, according to the investigator. DHS and UCare referred this case to the Medicaid Fraud Control Unit of the Minnesota Attorney General’s Office which prosecuted the case.
At sentencing, Farah was ordered to serve 30 days in the Hennepin County Workhouse, pay restitution of $12,428 and was placed on probation for three years. DHS was also able to recover additional overpayment funds from the Associated Clinic of Psychology.
In addition, Farah has been excluded as a provider by the U.S. Department of Health & Human Services.
A Stacy woman pleaded guilty in April to submitting false claims for reimbursement as a personal care assistant (PCA) when the person she allegedly was caring for was in hospice care. Suzette M. Wenger also submitted claims and received payment from DHS for PCA services she claimed she provided after the recipient passed away.
The DHS Office of Inspector General received a hotline complaint alleging that Blessing Home Health Services, Inc. billed for services that did not occur. DHS investigators followed up with an onsite visit and reviewed records kept by Blessing. The documentation showed that Wenger submitted timesheets for $2,226 for work she didn’t provide. Based on the overpayment determination, Wenger was issued a notice of suspension that prevented her from working for two years for a provider who receives Medical Assistance funding.
Wenger did not appeal her suspension which went into effect in March 2015. The case was referred to the Minnesota Attorney General’s Office for consideration of criminal charges. The Office’s Medicaid Fraud Control Unit confirmed that Wenger submitted false claims resulting in the defendant being charged with two counts of Theft by False Representation.
On April 22, 2016, Wenger entered a guilty plea to one count of Theft by False Representation. By agreeing to complete the conditions of Project Remand, Inc., Wenger received a stay of adjudication up to three years and agreed to pay restitution totaling $1,471.
A Forest Lake couple was given jail time and ordered to pay restitution after applying for public benefits for which they were not eligible. In 2011, Eric Vacko and his wife, Brittany, applied for public assistance following the birth of their child while living with a relative. They claimed they had no income, jobs or bank accounts. However, court records indicated that the Vackos worked in various business ventures, including an auto dealership.
Both Eric and Brittany Vacko entered Alford pleas, meaning they did not admit wrongdoing but acknowledged that the prosecution had enough evidence for a conviction.
Brittany is now serving a 180-day sentence in a Ramsey County correctional facility and was ordered to pay $146,822. Eric will begin serving his 180-day sentence at the end of September and will be required to pay $141,697 in restitution.
A Champlin woman who fraudulently obtained MinnesotaCare insurance and continued to lie about her eligibility for eight years was convicted of a felony for Wrongfully Obtaining Assistance – Theft by False Statements. At her February 2016 sentencing, Stacey Lynn Woolley was sentenced to 180 days in the Hennepin County workhouse, required to serve a three-year probation period and ordered to pay restitution totaling $44,760 within three years.
The DHS Office of Inspector General (OIG) received a fraud referral concerning Woolley. An investigation revealed that she not only had unreported income, but she also worked at an undisclosed job that nearly doubled her income. She was offered health insurance through her employer but declined it. Each of these factors would have precluded her from being eligible to receive MinnesotaCare insurance.
Wooley provided false information on her initial MinnesotaCare application and continued to falsify information on seven consecutive renewal forms.
The DHS Office of Inspector General began investigating AAA Plus Home Health Care in early 2011 after the department identified an overpayment of approximately $93,000. The agency was owned by Abdi Ali. Among the issues identified in the investigation were:
In 2012, DHS began withholding payments to AAA Plus Home Health Care and the case was turned over to the Minnesota Office of the Attorney General Medicaid Fraud Control Unit. The fraud unit charged the home care agency and manager Rufo Mumed with theft. In October 2015, the home health care agency and Mumed were convicted of theft and ordered to pay $20,164 in restitution. In addition, the provider numbers for AAA Plus Home Health Care, Mumed and Ali are terminated which prohibits them from billing for Medicaid (Medical Assistance).