9 January 2013 Medicaid fraud

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Home Health Care Agency Operator Charged With Health Care Fraud

MINNEAPOLIS—Yesterday in federal court, the operator of Lucky Home Health Care, Inc., a home health care agency in Minneapolis, was charged with defrauding Medicaid. On January 8, 2013, Abshir Mohammed Ahmed, age 40, of Minneapolis, was charged via an Information with one count of health care fraud.

Allegedly, from January of 2008 through June of 2011, Ahmed defrauded Medicaid, a federal health care benefit program, out of more than $400,000 by submitting fraudulent billings. Ahmed submitted claims that falsely represented that home health care services were purportedly provided by identified Personal Care Assistants (“PCA”) that were not in fact provided by those PCAs.

For example, a claim for reimbursement, submitted on July 16, 2009, billed Medicaid $1,330.56 for PCA services allegedly, but not actually, provided by the identified PCA.

The Medicaid program provides medical care and services to low-income people who meet certain income and eligibility requirements. Home health care, provided by PCAs, is one of the services reimbursed by Medicaid.

If convicted, Ahmed faces a potential maximum penalty of ten years in federal prison. All sentences will be determined by a federal district court judge.

This case is the result of an investigation by the Federal Bureau of Investigation. It is being prosecuted by Assistant U.S. Attorney David M. Genrich.

The U.S. Attorney’s Office participates in a task force with the Medicaid Fraud Control Unit at the Minnesota Attorney General’s Office that focuses on home health care fraud trends. The task force includes the U.S. Department of Health and Human Services-Office of Inspector General, the FBI, the Internal Revenue Service, and other federal, state, and local law enforcement partners.

As a result of federal convictions for health care fraud, defendants are excluded from participating in federal health benefit programs, including Medicare and Medicaid. Exclusion determinations are made by the U.S. Department of Health and Human Services. Nationwide, more than 3,000 individuals were excluded from program participation in Fiscal Year 2010 based upon criminal convictions or patient abuse or neglect, license revocations, or other factors.

A defendant, of course, is presumed innocent until he or she pleads guilty or is proven guilty at trial.

USAOMN