Attorney General Ellison indicts eight in $2.6 million Medicaid fraud scheme Featured

Alleges defendants stole identities from hundreds in Faribault area to bill Medicaid for services not received or provided or ineligible for reimbursement.

 May 3, 2024 (SAINT PAUL) — Minnesota Attorney General Keith Ellison announced that his office today charged eight people in Rice County District Court as part of a nearly 2-year scheme to defraud Minnesota’s Medicare program (Medicaid). .6 million dollars. As part of the scheme, the eight co-conspirators engaged in a broad identity theft scheme in which they used the stolen identities of hundreds of separate individuals, mostly from the Faribault area, to bill the Medicaid program for services which the victims did not do. receive and which the conspirators did not offer. Collectively, the co-conspirators are charged with 67 crimes, including racketeering, theft and identity theft.
The co-conspirators’ conduct primarily involves fraudulently billing Medicaid for transportation, interpreter, and specialty clinic services, including acupuncture, physical therapy, chiropractor, and mental health services, that were not provided at all or were not eligible for reimbursement from the Medicaid program.

“Minnesotans who receive health care have a right to expect to receive all the care, dignity and respect to which they are entitled. Minnesotans trying to make ends meet have a right to expect that every one of their tax dollars is spent properly and legally. Individuals who commit Medicaid fraud violate both rights. My office and our partners are working aggressively to hold these and all criminals accountable – and we will continue to do so,” said Attorney General Ellison.
The identity theft victims mainly lived in the Faribault area. Their identities were used to bill for Medicaid-funded services throughout the Twin Cities, often 50 to 60 miles from the victims’ homes in Faribault, despite specialty clinics providing the same services much closer to their homes. UCare, the primary insurance company payer for these services through Minnesota’s managed care program, will allow members to travel up to, but not more than, 60 miles for a medical service without pre-authorization. In this scheme, the co-conspirators often directed victims to clinics that were just under the 60-mile limit that would otherwise require pre-authorization. This allowed transit drivers who were part of the program to maximize their reimbursement for driving residents.

Once they obtained the victims’ identities, the co-conspirators illegally used them to fraudulently bill Medicaid by:
• Billing for transportation or interpreter services that were not provided at all;

• Billing for transportation services that were provided as group rides but billed as individual rides, resulting in a dramatically increased reimbursement rate;

• Billing for services that were not eligible for reimbursement because UCare prohibited interpreters from working as providers;

• Billing for services ineligible for reimbursement because the co-conspirators engaged in the prohibited solicitation or recruitment of victims to receive health care services at a particular clinic.

Nasro Aden Takhal, the lead actor, is charged with one count of fraud, six counts of identity theft and ten counts of aiding and abetting felony theft. Her co-conspirators Fardosa Ali Ibrahim, Bashir Aden Bare and Warfa Osman Mohomud are also charged with fraud, identity theft and aiding and abetting felony theft. Other co-conspirators Omar Abdi Ahmed, Amal Mohamed Budul, Khalif Abdi Madobe and Bishara Salat Abdirahman are charged with identity theft and accessory to theft.

This case is part of the multi-year, multi-agency PITSTOP 66 investigation. This case was the product of a joint investigation by the Medicaid Fraud Control Unit (MFCU) of the Office of Minnesota Attorney General Keith Ellison and the Office of Inspector General of the Department of Health and Human Services (DHHS/OIG) and the Minnesota Commerce Fraud Office . . The agencies received substantial assistance from the Federal Bureau of Investigation and the Minnesota Department of Human Services Crime Lab. The Minnesota MFCU in the Minnesota Attorney General’s office is prosecuting the case.

“HHS-OIG is committed to protecting our communities and taxpayer funds from schemes that target Minnesota’s Medicaid program, which provides needed services to vulnerable populations,” said Special Agent in Charge Mario M. Pinto of the US Department of Health and Human Services. General (HHS-OIG). “HHS-OIG appreciates the continued partnership with the Minnesota Attorney General’s Medicaid Fraud Unit and other law enforcement partners and will continue to investigate those who threaten the integrity of federal and state health care programs and individuals served by them”.

So far, 9 people have been convicted as a result of the PITSTOP 66 enforcement effort, including chiropractors, mental health therapists, performers and transport drivers. Others are currently facing charges. Additional charges are expected against others, including owners and employees of other Medicaid-funded clinics and health care companies, as the investigation continues.

A criminal complaint is only an accusation, and defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Minnesota MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant 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.

Source: DNKL