Medicaid swindle alleged: A Brooklyn Park couple are accused of overbilling the state by $975,000 for at-home care

A Brooklyn Park couple were charged Thursday with swindling the state's Medicaid program out of nearly $1 million by allegedly submitting false claims for home care and nursing services. The criminal complaint alleges that Sole Provider Nursing Services billed the state's Personal Care Assistance program (PCA) between 2006 and 2008 for home care of patients who were in the hospital and submitted claims for workers it didn't employ.

The PCA program, designed to help frail and elderly people stay in their homes, more than doubled in size during the past decade and became ripe for billing irregularities, according to a 2009 report by the Office of the Legislative Auditor.

The charges against Sole Provider also says the agency submitted bills showing care aides working more than 24 hours in a single day and, in one case, 42 hours a day for a week straight.

In all, it alleges overbilling of $975,295. Named in the complaint were Anita Gayle Soledolu, 39, owner of Sole Provider Nursing Services, and her husband, Stephen Adewale Soledolu, 32. The couple could not be reached.

Legislative Auditor James Nobles found hundreds of cases in which care agencies billed the state claiming that employees worked more than 24 hours in a day.

The Human Services Department subsequently changed its billing rules and placed limits on the hours that personal care attendants can work -- though a 2010 Star Tribune investigation found periodic breakdowns in enforcement of that rule.

The state Department of Human Services discovered irregularities in billings by Sole Provider Nursing Services in 2008 and froze its payments that year.

The case came to light before that rule change and was referred to the attorney general's office for investigation in May 2008.

"Fraud in programs intended to help the most vulnerable Minnesotans is unacceptable,'' Human Services Commissioner Lucinda Jesson said in a statement Thursday.

"We must do all we can to find and prevent it.''

The department said the computer system that processes health care claims now automatically denies PCA claims for more than 24 hours of services a day or 275 hours of service in a month. It is also supposed to reject claims for PCA services when a client is known to be in the hospital.

"We will continue to intensify efforts to prevent fraud from occurring in the first place," Jesson said. Medicaid, known in Minnesota as Medical Assistance, is a state-federal health insurance program for the poor, the disabled and the elderly poor.

Minnesota Attorney General Lori Swanson said the program is a "safety net to the most vulnerable adults and children in our state, and each taxpayer dollar that is fraudulently diverted means it is not going somewhere else where it is needed.''

Star Tribune
Article Publish Date: 
February 25, 2011