Minnesota

May 27, 2010

Minnesota Autism Center to pay U.S., State of Minnesota, to resolve claims of improper billing, receipt of Medicaid funds (U.S. Attorney for the District of Minnesota)

Minnesota - The Minnesota Autism Center (“MAC”) has entered into an agreement with the federal government and the State of Minnesota to settle allegations that it improperly billed the federal Medicaid program for autism therapy services. Under the terms of the agreement, signed on May 26, 2010, MAC will pay $600,000 to the United States. That settlement amount will be divided approximately in half between the federal government and the State of Minnesota, through the Minnesota Department of Human Services (“DHS”), which administers the Medicaid program here in Minnesota.

The MAC, based in Minnetonka, is a health care provider that delivers therapy services to

children and families affected by autism, a disorder that alters the brain’s normal development of social and communication skills. The government investigated the MAC regarding two main allegations related to simultaneous billing and inappropriate billing for client-related activities.

Relative to the simultaneous billing allegation, the U.S. asserts the MAC was on notice that it could only bill for skills training simultaneously provided to a child and the child’s family if it received prior authorization to do so. However, the U.S. contends that the MAC routinely billed for the simultaneous services without receiving such authorization.

The client-related activity allegation focused on the MAC’s excessive billing with respect to services such as recordkeeping and charting. The alleged misconduct took place in 2004 and 2005.

In the settlement agreement, the MAC denies the allegations set forth by the United States and the State of Minnesota and states that it views the agreement merely as a “compromise of disputed claims.” Notwithstanding that, the MAC agrees to provide the United States with the $600,000 in settlement within the next seven days. In return, the United States and the State of Minnesota agree to release the MAC from all claims related to the covered conduct during the relevant time period. The MAC may also continue to participate in the Medicaid program.

This matter resulted from an investigation conducted by the Minnesota Attorney General’s Office and the United States Department of Health and Human Services-Office of Inspector General. Assistant U.S. Attorney Chad Blumenfield represented the U.S.

December 15, 2009

Plymouth man Pleads Guilty to Defrauding Medicaid out of $74,000 (U.S. Attorney for the District of Minnesota)

The owner of a home health care company pleaded guilty on Dec. 15, 2009, in federal court to obtaining $74,000 from Medicaid fraudulently by causing submission of reimbursement claims for personal care assistant (“PCA”) services that, in truth, were not rendered. In connection to this crime, B. Bennie Perkins, age 58, of Plymouth, pleaded guilty to one count of conspiracy to commit health care fraud. He entered his plea in St. Paul before United States District Court Judge Paul A. Magnuson. Perkins was charged on November 30, 2009.

In his plea agreement, Perkins, the owner and operator of Healthcare Options, admitted orchestrating the scheme from January 6, 2007, to February 28, 2008. The scheme involved submitting false claims to the Minnesota Department of Human Services, which administers the Medicaid program in Minnesota. Medicaid provides medical care and services to low-income people who meet certain eligibility requirements. PCA services are provided to Medicaid recipients who require assistance with personal care in their residence. Those services usually are provided by a PCA employed by a home health care provider, such as Healthcare Options.

Perkins faces a potential maximum penalty of five years in prison for his crime. Judge Magnuson will determine his sentence at a future date. This case is the result of an investigation by the U.S. Department of Health and Human Services-Office of Inspector General, the Social Security Administration, and the Medicaid Fraud Control Unit at the Minnesota Attorney General's Office. It is being prosecuted by Assistant U.S. Attorney David M. Genrich.

According to the Justice Department, health care fraud investigations have been growing steadily, and on May 20, 2009, the Department announced the formation of a senior-level task force to tackle health care fraud throughout the country. The Health Care Fraud Prevention and Enforcement Action Team (“HEAT”), represented by the departments of Justice and Health and Human Services, examines ways to share real-time intelligence data on health care fraud patterns and practices more efficiently. It also disseminates critical information about health care services as well as pharmaceuticals and medical devices. In 2008, the Justice Department filed criminal charges in 502 health care fraud cases involving 797 defendants.

For more information, visit the website of the United States Attorney's Office for the District of Minnesota at:  http://www.usdoj.gov/usao/mn/index.html

June 18, 2009

Eden Prairie Man Sentenced For Health Care Fraud, Money Laundering (U.S. Attorney for the District of Minnesota)

A 52-year-old Eden Prairie man was sentenced today in federal court in connection with a conspiracy against Medica, which administers the Medicaid public health care benefit program in Minnesota.

On June 18 in Minneapolis, United States District Court Judge Joan Ericksen sentenced Mohamed Essa to 44 months in prison and three years of supervised release on one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering. Essa was also ordered to pay restitution of $1,754,096.38 to Medica jointly and severally with his co-defendants, his wife Indadeeq Omar and Tou Chaiker Vang, a former employee of Medica.

Essa was indicted on March 13, 2007, while out of the country. He failed to return to face the charges and was apprehended on April 10, 2008, in South Africa. He pleaded guilty on Sept. 26, 2008.

According to Essa’s plea agreement, he admitted that from Jan. 1, 2001 through December 2004, he did unlawfully and knowingly conspire with Indadeeq Omar and Tou Chaiker Vang to execute a scheme to defraud Medica and to obtain approximately $1.5 million by means of false and fraudulent pretenses. The object of the conspiracy was to fraudulently obtain money from Medica by submitting claims for translation services that had not been rendered to Medica members.

Essa and Omar owned and operated Global Interpreter Corp., which contracted with Medica to provide translation services to members who required such services when being treated by health care providers. Vang was employed by Medica in the State Public Programs customer service department. The plea agreement states that Essa and Omar obtained Medica member information and dates of medical visits from Vang so that they could submit the false claims for translation services that corresponded with dates on which members had actual medical visits, and that they caused false documents to be prepared in an effort to justify the false claims to Medica and to conceal the scheme.

Essa also admitted that from Jan. 1, 2001, to Oct. 11, 2004, he unlawfully conspired with Omar and Vang to knowingly conduct and attempt to conduct financial transactions affecting interstate commerce, with each transaction involving the proceeds of the conspiracy to commit health care fraud, with the intent to promote the fraud and to disguise the source of the illegally obtained proceeds.

The plea agreement states that Omar prepared Global Interpreter checks listing fictitious interpreters as payees; that Essa and Omar provided a number of these checks to Vang, who negotiated the checks at various financial institutions; and that Omar structured the deposit of sham payroll checks payable to fictitious persons to conceal the source and nature of the fraudulent proceeds. Essa admitted that the checks were intended to promote the health care fraud conspiracy because they caused Vang to continue to provide Medica information to him and Omar.

On July 17, 2008, Omar, 45, was sentenced to 72 months in prison, along with three years supervised release on one count of health care fraud conspiracy, 12 counts of health care fraud, one count of money laundering conspiracy, 19 counts of concealment money laundering and seven counts of promotion money laundering. She was convicted by a federal jury in December 2007.

On April 11, 2008, Vang, 39, Maplewood, was sentenced to one year and one day in prison, three years of supervised release, and was ordered to assist Omar in paying more than $1.7 million in restitution. Vang pleaded guilty to one count of money laundering conspiracy and one count of health care fraud conspiracy.

This case was the result of an investigation by the Internal Revenue Service-Criminal Investigation Division and the U.S. Department of Health and Human Services-Office of Inspector General, with the assistance of the Medica Special Investigations Unit, and the U.S. Department of State-Diplomatic Security Service. It was prosecuted by Assistant U.S. Attorneys William J. Otteson and John R. Marti.