Attorney General Ellison charges three in largest-ever Medicaid fraud prosecution by AGO

Three defendants arrested, charged with 24 counts totaling $11 million in fraud

December 7, 2023 (SAINT PAUL) — Minnesota Attorney General Keith Ellison announced that his office charged three people today as part of a scheme to defraud  the Minnesota Medical Assistance (Medicaid) program out of nearly $11 million. This is the largest Medicaid fraud prosecution charged by the Minnesota Medicaid Fraud Control Unit (MFCU).

Abdirashid Ismail Said, the principal actor, is charged with one count of racketeering, eight counts of aiding and abetting theft by swindle (over $35,000), and one count of perjury for defrauding the Medicaid program through his operation of three separate Medicaid-funded home health care agencies: Faym Health, LCC, Prestige Health, LLC, and Minnesota Home Health Care, LLC. Said’s co-conspirators, Ali Abdirizak Ahmed and Said Awil Ibrahim, are also charged in Hennepin County district court with racketeering and aiding and abetting theft by swindle (over $35,000). 

“Minnesotans who receive Medical Assistance have a right to expect that they’ll receive all the care, dignity, and respect they’re entitled to. Minnesotans trying to afford their lives have a right to expect that every one of their tax dollars will be put to use properly. People who commit Medicaid fraud violate both of those rights. My office is working aggressively to hold them accountable and will keep doing so,” Attorney General Ellison said.

The MFCU has previously charged and prosecuted Said: in 2022, Said was convicted of Medicaid fraud, ordered to repay the State $77,000, and barred from working with any Medicaid-funded agency. Following his conviction, other agencies operated by Said billed the Medicaid program for providing both home and community based waivered services and personal care assistant (PCA) services.  Faym, owned by Ahmed, and Prestige, owned by Ibrahim, billed the Medicaid program for providing home and community based waivered services.  Minnesota Home billed the Medicaid program for providing PCA services.

In today’s complaint , the Attorney General’s Office alleges Said and his co-conspirators defrauded the Medicaid program by:

• Billing for services ineligible for payment because Said was barred from operating any Medicaid-funded agency following his conviction. Following his conviction, Said was prohibited under both State and Federal law from working in any role with a Medicaid-funded agency.  Said was not documented as an owner or managing employee at Faym, Prestige, or Minnesota Home.  Yet as documented in the 24-page probable cause statement, MFCU Investigators found voluminous documentary, digital, and financial evidence indicating Said operated Faym, Prestige, and Minnesota Home.  Additionally, numerous former employees and clients, and one case manager, told MFCU Investigators that Said illegally operated these agencies.   Minnesota law prohibited Said’s agencies from receiving any Medicaid funds at all, yet the agencies received over $10.9 million while Said operated them without disclosing his involvement.
• Billing for waivered services that were not documented or that were based on fraudulent documentation. Waivered services agencies are required by Minnesota law to have a designated coordinator and designated manager (DC/DM) on staff to provide instruction and assistance to workers, in order to ensure the agency’s clients are receiving waivered services consistent with their service plan.  MFCU Investigators interviewed a DC/DM at Faym who acknowledged that she created fraudulent documentation for both recipients and workers at the agencies.  The DC/DM further stated that Said and his co-conspirators knew the documentation was fraudulent, and that she was paid to create it.  Financial evidence showed that the DC/DM received over $73,000 from Faym. Based on the fraudulent documentation reviewed and the DC/DM’s statements, MFCU Investigators determined that Faym was paid over $4.6 million for services based on this fraudulent documentation.

The investigation also found that the agencies routinely billed for services not provided at all, for more services than documented in employee timesheets, for PCA services that were not supervised by a Qualified Professional (as required by Minnesota law).  Often, these findings resulted from workers or clients who said they did not receive any services from the agencies, despite the agencies billing for services provided to them.  MFCU investigators found that, between all of the agencies, Said and his co-conspirators billed $997,000 for recipients who denied receiving services, overbilled for over $300,000, and billed over $5.8 million for services that were not documented or were fraudulently documented.

From May 2019 to May 2023, the three owners and their agencies often wrote large checks and transferred funds between each other without any legitimate business purpose.  Furthermore, during a probation violation hearing related to his prior conviction, Said testified under oath that did not have any ownership, management, employee, or contractor role at any of the agencies.  Based on the voluminous digital evidence, including frequent text messages from Said to the agency owners, employees, or clients about Medicaid-funded services, these statements were false.

Four other people have been previously charged as part of this investigation.  Additional charges are expected against other individuals, including owners and employees of other agencies, as the investigation continues.

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

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

“Individuals who seek illicit gains from Medicaid, do so to the detriment of those beneficiaries who rely on the continued solvency and integrity of these vital federal health care programs,” said Mario M. Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General.  “Our agency is committed to working together with our state law enforcement partners to ensure that those who engage in fraud are held accountable.”

The Minnesota MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,854,024 for Federal fiscal year 2023.  The remaining 25 percent, totaling $1,284,670, is funded by the State of Minnesota.