Personal Care Assistant (PCA) Medicaid Fraud Defense
In Minnesota, some PCAs are now being investigated for alleged Medicaid fraud—billing for personal care assistant services that were never performed or were performed not in accordance with the documented services. Personal Care Assistants (PCAs) means an individual employed by a personal care assistance agency who provides personal care assistance services.
What Is Medicaid And How Is It Administered?
The Medicaid program provides medical care and services to Minnesotans who meet income and other eligibility requirements (recipients). The Medicaid program is administered by the DHS. The DHS contracts with or enrolls providers to furnish health care services and goods to Medicaid recipients, some of whom receive their services on a managed care basis through one of Minnesota’s managed care organizations (MCO) like Medica. Health care providers wishing to furnish health care services to recipients must enroll in the Medicaid program by entering into an agreement. Providers then submit claims directly to DHS or the MCO, which then reimburses the provider in Medicaid funds.
Under Medicaid guidelines, personal care services are provided by a personal care assistant (PCA) who is employed by a Personal Care Assistance Services Agency (Agency) for the purpose of providing personal care necessary to maintain a recipient in his or her residence. A PCA is required to accurately document the time he or she spends with a recipient on a timesheet. The PCA then submits the timesheets to the Agency, which bills the DHS or MCO for PCA services based on the information reported in the timesheet. DHS or the MCO reimburse the agency, and the agency pays the PCA.
Medicaid covers PCA services, which include assistance with activities of daily living like dressing, grooming, bathing, eating, mobility, and toileting. Unless certain limited exceptions apply, PCA services occur in a recipient’s home and are documented on a timesheet.
If you are under investigation or have been charged with committing the crime of health care fraud in Minnesota, you need an attorney with experience defending against these types of charges.
Call (651) 468-2108 for a free initial consultation with the attorneys at RAM Law PLLC.
What Government Agencies Investigate Criminal, Civil, and Administrative Medicaid Fraud?
Doctors, RNs, LPNs, PCAs, and other medical professionals often become the subject of health care fraud investigations due to poor or inadequate record keeping. These investigations are often initiated by the Minnesota Department of Human Services (DHS), by the Medicaid Fraud Control Unit (MCFU) of the Minnesota Attorney General’s Office, by the Department of Human Services Surveillance Integrity Review Section (SIRS), or by licensing boards. These departments often allege the submission of false, inflated, or inaccurate timesheets for medical services that were not allegedly provided. Furthermore, these agencies have been known to trick providers into confessing to committing crimes that were not actually committed. DHS, MCFU, and SIRS often refer their investigations to prosecutors that charge individuals with Theft by False Representation of Public Funds, Minn. Stat. 609.52, and Aiding and Abetting Theft by False Representation of Public Funds, Minn. Stat. 609.52. Said agencies often allege over billing or billing for medical services that were not performed.
If you are under investigation or have been charged with committing the crime of health care fraud in Minnesota, you need an attorney with experience defending against these types of charges.
Call (651) 468-2108 for a free initial consultation with the attorneys at RAM Law PLLC.
Criminal defense and medical license defense attorneys at RAM Law PLLC are experienced with litigating sophisticated alleged Medicaid fraud and provide representation in the following matters:
· Medicaid Fraud
· Billing Fraud
· PCA Fraud
· Home Care Fraud
· Nursing Home Fraud
· Private Duty Nursing Fraud (PDN Fraud)
Call (651) 468-2108 for a free initial consultation with the attorneys at RAM Law PLLC.
PCAs, Nurses, And Physicians Can Be Investigated For Medicaid Fraud Due To Good Faith Mistakes
Health care and Medicaid fraud charges are very serious allegations often levied against individuals that have never been charged with a crime, who inadvertently fail to comply with sophisticated laws, rules, and regulations created by the many state and federal agencies that regulate the medical field in Minnesota.
Honest mistakes may lead to unfair criminal charges of health care or Medicaid fraud in Minnesota. These charges often stem from innocent, good faith misunderstandings since the regulations and processes involved with public health care programs are complex. Furthermore, many individuals receive inadequate training to properly bill for medical services. At RAM Law PLLC, we understand that good people make honest mistakes.
Should I Speak With Medicaid Fraud Investigators Without An Attorney?
In short, no—it is wise for medical providers to not speak with anyone that is investigating Medicaid fraud without having an attorney present. Anything a medical provider says to a Medicaid fraud investigator can and will be used against them, as their statements and records may lead to criminal charges being filed.
Just because you have been charged with health care fraud in Minnesota does not mean that you will be convicted.
Call or text (651) 468-2108 if you have been accused, investigated, or charged with health care fraud to speak with the attorneys at RAM Law PLLC.