Rebecca Swanson, the owner of a personal care provider organization, was sentenced June 5, 2017 in 5th District Court for Theft by False Representation. She plead guilty to preparing and filing false claims for reimbursement for medical care so she could be reimbursed with Medical Assistance (Medicaid) funds. Swanson was found guilty on six counts of Theft by False Representation, a felony, and will be required to pay back $601,378 to DHS along with court fees.
In addition, Swanson will be serve one year on work release and is on probation for 20 years, ending in June 2036.
This case originated with the Department of Human Services fraud division when a former employee of the company owned by Swanson, Mybeck, Inc., notified DHS of a background study issue. This prompted DHS to begin an investigation that involved reviewing claims that Mybeck submitted. The DHS Surveillance and Integrity Review Section (SIRS) unit attempted an onsite review at the company’s office in Mankato but was denied access. At this point the case was turned over to an investigator with the Minnesota Attorney General’s Office Medicaid Fraud Control Unit (MFCU).
After a thorough investigation that involved reviewing claims and interviewing numerous former PCAs and clients, as well as Swanson and her husband, the MFCU investigator concluded that Swanson engaged in four separate schemes to defraud DHS. The schemes involved submitting claims:
Under the wrong treating provider number
For PCA services that were not supervised by qualified professional
For PCA services provided by disqualified PCAs, and
For time in excess of that claimed to have been provided by the PCAs as indicated by their timesheets.
In addition to paying restitution, being placed on work release for a year and being on probation for 20 years, Swanson will no longer be allowed to work in any capacity involving direct contact with Medicaid funds.
Two Mankato residents were recently indicted and charged with one count of conspiracy to commit public assistance fraud totaling over $75,000 in federal court in Minneapolis.
Kyle Kirschman, 52, owned a house in Mankato that was divided into two apartments. He had applied to the federal government to have one of the apartments designated as Section 8 housing. In 2006, Kirschman and Holly Bloom, 37, entered into a lease for Bloom and her family to live in the Section 8 apartment. Section 8 housing regulations require that no member of Kirschman’s or Bloom’s family can be related and that the Section 8 apartment, as agreed upon in the lease, was the only residence of the Bloom family.
Around this same time, Bloom applied for the Supplemental Nutrition Assistance Program and Medical Assistance benefits. She didn’t list Kirschman as a member of her family.
According to the indictment, Bloom claimed for at least six years that she lived in the second apartment. Yet from June 2007 through February 2014 Kirschman and the Bloom families lived in both apartments. During this time, Kirschman was an immediate family member of someone in the Bloom family. As a result, Kirschman unlawfully received Section 8 rental subsidies. In addition, Bloom was unlawfully receiving public benefits because Kirschman was a member of Bloom’s household, was continuously employed and earned an income that disqualified the household from receiving such benefits.
This case is the result of an investigation involving the Blue Earth County Sheriff’s Office Welfare Fraud Prevention Investigator and the U.S. Department of Housing and Urban Development Office of Inspector General.
A Claremont woman who falsified a doctor’s report in order to continue receiving public assistance pleaded guilty to wrongfully obtaining assistance, theft by false statements, concealment and impersonation.
Between April 2013 and June 2016, April Cortez and another individual were overpaid $61,907 in public assistance. Initially a doctor had written a report stating that Cortez was unable to work for a specific period of time. Additional reports were submitted that extended the timeframe for Cortez but these reports were falsified according to the Mayo Clinic physician. No reports had been completed for the other individual.
When Cortez learned that a fraud prevention investigator was gathering evidence in this case, she acknowledge that she had provided some misinformation. She also stated that she would like to repay the money and be disqualified from assistance rather than have the brought the case to the attention of law enforcement.
Cortez will be sentenced in early April. No charges have been filed against the other individual.
In September 2015, Ummah Child Care Center, Inc. was charged in Hennepin County with theft by swindle, a felony, for improper billing resulting in fraudulently obtaining state program funding. Ummah pleaded guilty on Jan. 3, 2017.
As a result of the conviction, the center was ordered to pay $37,000 in restitution and a $10,000 fine. In addition, on Sept. 28, 2015, the date the criminal complaint was filed, the center had its assets frozen. Once the restitution and fines are paid to the Department of Human Services (DHS) and Hennepin County District Court, respectively, the freeze on Ummah Child Care Center’s bank account will be lifted.
The center, which became a licensed child care facility in August 2013, is one of the largest recipients of Child Care Assistance Program (CCAP) funds in the state. Based on the high level of billing by this center, along with additional information, an investigation of the child care center took place over 31 days between April 24 and June 21, 2015. The investigation involved counting the number of children who entered the child care center over this time period.
During a single week in April, Ummah billed for 551 children even though investigators observed 459 children attending the center. That means the center billed for 92 children who did not actually attend the center that week.
When calculating the degree of fraud, DHS investigators used the lowest billing rate (the amount charged for a school age child) even though many of the children seen entering the center were likely younger and therefore billed at a higher rate. During this one particular week of the investigation, Ummah fraudulently received $4,944. Overall, during the surveillance period Ummah submitted bills and obtained CCAP funds for 2,253 children attending the center when actually only 1,896 children were present during that time.
In addition to being charged with theft by swindle, and paying restitution and a court fine, the authorized biller for Ummah Child Care Center, Hamdi Ahmed Nur, agreed to be disqualified from working for, owning or being involved in a child care center or child care provider that is required to be licensed by DHS or any county, or receive funding from CCAP. The disqualification will last two years after which time Ahmed Nur will be subject to a background study as is required of all licensed child care providers.