Attorney General's Office charges five with $9.5M in Medicaid fraud
August 30, 2023
August 29, 2023 (SAINT PAUL) — Minnesota Attorney General Keith Ellison announced today that his office has charged five people as part of a scheme to defraud the Minnesota Medical Assistance (Medicaid) program out of approximately $9.5 million. To date, this is the largest Medicaid fraud prosecution charged by the Minnesota Medicaid Fraud Control Unit (MFCU) of the Attorney General’s Office.
The owners of the personal care assistant (PCA) services agency called MN Professional, Abdikarim Mohamed and Ahmed Nur, along with managers Abubakar Ahmed and Ali Elmi and biller Omar Dirie, are each charged in Hennepin County District Court with 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).
“Minnesotans who receive Medical Assistance have a right to expect they’ll receive all the care, dignity, and respect they’re entitled to. 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,” Attorney General Ellison said.
Scope of the alleged fraud
The Attorney General’s complaint alleges that together, the five individuals charged today used MN Professional to defraud the Medicaid program by:
• Billing for services not provided. As documented in the 18-page statement of probable cause, MFCU investigators found that MN Professional fraudulently billed the Medicaid program for more than 25,000 hours of services that were not provided. The investigation found that without the knowledge of personal care assistants, MN Professional frequently billed as if PCAs provided services to clients whom the PCAs did not know or recognize when shown photographs. In interviews with MFCU investigators, PCAs regularly stated that they did not provide services to recipients that were billed under their name and provider number. MN Professional received more than $1.6 million for services billed but not provided.
• Billing for PCA services that were not supervised by a nurse or other qualified professional. To protect the health and safety of clients, and to ensure clients receive appropriate and medically necessary care from their PCA, Minnesota law requires that PCA services be supervised in regular intervals by a registered nurse, mental-health professional, or other individual defined by law as a qualified professional (QP). MFCU investigators found that at times, MN Professional clients went years without any supervision by a QP. Minnesota law further mandates that PCA services must be supervised by a QP to be eligible for payment from Minnesota’s medical assistance program. MN Professional received more than $7.8 million in Medicaid funds for the unsupervised PCA services of at least 120 clients.
The Attorney General’s complaint further alleges the individuals charged then concealed the proceeds of their crimes through an elaborate check-cashing scheme. The individuals frequently wrote checks in the names of PCAs whose identities were used to bill fraudulently, cashed the checks written in others’ names, and kept the cash for themselves. As a result of this scheme, some PCAs received artificially inflated W2s that indicated they received wages from MN Professional that they did not.
Abdikarim Mohamed and Ahmed Nur, the two owners of MN Professional, also fraudulently listed their wives as “board members” and “consultants” at MN Professional and paid them hundreds of thousands of dollars in “salary.” The “salary” went into joint bank accounts where Mohamed and Nur had the ability to withdraw or transfer the funds into their own accounts.
The individuals engaged in other illicit activities described in the complaint as well, including recruiting clients and PCAs with the intent of using them to defraud the Medicaid program and falsifying information to obtain loans related to COVID-19 relief programs.
A criminal complaint is merely an allegation, and the defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Scope of the investigation
Thus far, 18 people have been charged as part of this investigation. Outside of the five individuals charged today who owned and ran MN Professional, seven other individuals who served as recruiters, an office manager, or PCAs have been charged, either today or earlier this month, with a total of 32 counts of aiding and abetting portions of the agency’s fraud and one count of identity theft. Six individuals were previously charged, five of whom pleaded guilty. Additional charges are expected against other individuals as the investigation continues.
This case was the product of a joint investigation by Medicaid Fraud Control Unit (MFCU) in the Office of Minnesota Attorney General Keith Ellison and the U.S. Department of Health and Human Services’ Office of Inspector General (DHHS/OIG). The agencies received substantial assistance from the Minnesota Commerce Fraud Bureau and the Minnesota Department of Human Services’ Forensic Lab.
“Providers who engage in schemes to defraud Federal health care programs, such as Medicaid, do so to the detriment of the beneficiaries who rely on their services, as well as taxpayers who fund these programs,” said Mario M. Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG is committed to working with our partners at the Minnesota Attorney General’s Office to ensure that those who defraud the Medicaid program are brought to justice.”
Under Minnesota Statutes Section 256.12, the Attorney General has original criminal and civil jurisdiction over Medicaid Fraud. The Minnesota MFCU in the Attorney General’s Office is prosecuting the case.
The Minnesota MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,854,024 for Federal fiscal year (FY) 2023. The remaining 25 percent, totaling $1,284,670 for Federal fiscal year (FY) 2023, is funded by the State of Minnesota.