Integrated Community Supports Fraud Charges In Minnesota
Can Billing Mistakes Be Considered Integrated Community Supports Fraud (ICS Fraud) in Minnesota?
Investigation into ICS fraud is no joking matter. The Minnesota Department of Human Services (DHS) conducts program integrity activities and investigations to ensure taxpayer dollars are used reasonably and appropriately. If you are being contacted by DHS concerning Integrated Community Supports, you may be investigated even if you believe you did not do anything wrong.
Can I Be Convicted Of Committing Crime(s) For ISC Billing Mistakes?
The short answer is no, but individuals are often charged anyway and are forced to defend themselves in court. ICS fraud requires intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and knowing the deception violates the law or the public trust and could result in unauthorized personal benefit or benefit to others.
What should I do if I am Contacted by Minnesota Department of Human Services (DHS) or the Minnesota Office of Inspector General?
Intentionally overbilling by even $1 is a felony under Minnesota law, often criminally charged as Theft by False Representation Public Funds pursuant to Minnesota Statute 609.52. Intentionally overbilling by $1 can also be criminally charged as a Felony Theft by Swindle. These criminal charges can carry a maximum prison sentence of 20 years depending on the alleged dollar amount.
Because this is serious business, call the lawyers at RAM Law PLLC at (651) 468-2108 before you make any statements to anyone including employees and investigators of the Minnesota Department of Human Services (DHS) or the Minnesota Office of Inspector General (OIG). Anything you say can be used against you in criminal and civil court. For this reason, it is always wise to speak with an attorney if you have reason to believe you are under investigation.
What Is Integrated Community Supports (ICS) Fraud?
In Minnesota, some Integrated Community Supports (ICS) agencies and providers are now being investigated for alleged Medicaid fraud—billing for ICS services that were never performed or were performed not in accordance with the documented services.
ICS services provide support and training/habilitation in community living service categories to adults age 18 and older who reside in a living unit of a provider-controlled ICS setting (e.g., apartment in a multi-family housing building). ICS can be delivered up to 24 hours per day in the person’s living unit or in the community.
What Are Support In Community Living Service Categories?
In Community Living Service Categories include cueing, skill maintenance, guidance, instruction, assistance with activities of daily living, assistance with coordination of community living activities or direct supervision within an allowable community living service category.
What Are Training In Community Living Service Categories?
Training in Community Living Service Categories are skill-building and instructional services to acquire, retain and improve the person’s experience living in the community within an allowable community living service category. Training must meet the person’s identified needs.
ICS covers training/habilitation and support to meet the person’s individualized assessed needs and goals in at least one of the communities living service categories:
Community participation
Adaptive skills
Health, safety and wellness
Household management
What is Community Participation?
Community Participation may include:
Community mobility and pedestrian safety (e.g., safely getting in and around the community)
Community resource use and access
Community safety and awareness
Informal support system and network development
Interpersonal communication skills
Leisure, recreation and socialization planning
Skill-building to meet transportation needs
Health, safety and wellness
This category may include:
Collaboration with the person to arrange health care (e.g., physical, mental, chemical), meaningful activities, social services, meetings and appointments.
Training or support to complete self-care activities, including ADLs.
If a person receives ICS, they cannot receive state plan or waiver services that duplicate ICS, such as:
24-hour emergency assistance
Adult foster care
Community residential services
Customized living (including 24-hour customized living)
Caregiver living expenses
Family residential services
Individualized home supports (without training, with training and with family training)
Night supervision services
Respite
A person who lives in an ICS setting is not required to receive ICS. However, when a person lives in an ICS setting, ICS can only be delivered by the provider who controls the setting. The provider who controls the ICS setting cannot deliver other HCBS services in the setting (except transportation and extended home care nursing). Failing to comply with the Minnesota ICS laws, rules, and regulations can result in serious consequences.
How Important is Documentation for ICS?
Documentation is everything when billing for ICS. Accurate and sufficient documentation can be the difference between prison and a “thank you for the clarification.” The lead agency must clearly document the person’s service needs and identify outcomes in the person’s support plan.
The ICS provider is responsible to provide written reports to the lead agency and the person at a minimum of once per year or the frequency established in the person’s support plan.
What Should I Do Now?
If you have questions about being questioned by anyone from the Minnesota DHS or OIG, do not wait, call (651) 468-2108 for a free confidential consultation with the attorneys at RAM Law PLLC.