Minnesota Medicaid and Healthcare Fraud Lawyers
Minnesota Criminal Healthcare Fraud Charges
Healthcare and Medicaid fraud charges are very serious allegations often levied against individuals who inadvertently fail to comply with sophisticated laws, rules, and regulations created by the many state and federal agencies that regulate the Minnesota medical field. Often, these charges are filed against healthcare workers who have no criminal record and have never been involved in the Minnesota criminal justice system.
Honest mistakes made by honest individuals may lead to unfair criminal charges of healthcare 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.
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) or by the Medicaid Fraud Control Unit (MCFU) of the Minnesota Attorney General’s Office, or by the Department of Human Services Surveillance Integrity Review Section (SIRS). These departments often allege the submission of false or inflated timesheets for medical services that were not 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, and Aiding and Abetting Theft by False Representation of Public Funds.
The Medicaid Program
The Medicaid program provides medical care and services to low-income Minnesotans (recipients) who meet certain income and other eligibility requirements. The Minnesota Department of Human Services (DHS), located in St. Paul, Minnesota, administers the Medicaid program.
The Medicaid program covers private duty nursing (PDN) services, including services provided by a nurse to a recipient or patient inside the recipient’s home. PDN services are intended for recipients whose medical conditions require individual and continuous care by a Registered Nurse (RN) and or a Licensed Practical Nurse (LPN). A recipient who qualifies for in-home nursing services may hire a PDN agency to furnish the nursing services.
PDN agencies must enroll with and apply to the Minnesota Department of Health for licensure. To be paid by Medicaid, private duty nursing services must be ordered by a physician. A Public Health Nurse must also assess the recipient, and then document in a recipient’s Care Plan the level of nursing services needed, along with the daily hours required to provide those services.
When a Medicaid recipient hires a PDN, the recipient and the PDN sign a Service Agreement. The Service Agreement incorporates the types of nursing services and the maximum level of services such as RN complex, LPN complex, RN regular, or LPN regular services. RNs are generally paid a higher hourly wage than LPNs, PCAs, or non-nurse care providers. Complex nursing services are reimbursed at a higher rate than regular nursing services.
This complex process often results in PDNs misunderstanding Medicaid rules or processes, and can even result in overbilling or mistaken billing. Billing discrepancies can result in criminal investigation or even charges. Healthcare workers who have been contacted by police, the Minnesota attorney general’s office, or federal agents concerning healthcare billing should contact an experienced Minnesota Medicaid or healthcare fraud attorney as soon as possible.
Attorneys Defending Against Healthcare Fraud Criminal Charges in Minnesota
If you are under investigation or have been charged with committing the crime of healthcare fraud, you need an attorney with experience defending against these types of charges. The attorneys at RAM Law PLLC represent clients against healthcare fraud charges, and have defended clients against various Medicaid Fraud, Billing Fraud, PCA Fraud, Home Care Fraud, Nursing Home Fraud, and Private Duty Nursing Fraud charges.
Contact our Minnesota healthcare fraud defense attorneys now by phone or text at 651-468-2108 or submit our convenient online consultation form.