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Home health care worker accused of fraud, advocates call out larger problem

June 11, 2019 06:32 PM

Fraud investigators with the Minnesota Attorney General's Office say a woman providing in-home services as a Personal Care Assistant (PCA) repeatedly billed the Medicaid program for work she never performed, costing state taxpayers nearly $10,000.

Court records reviewed by 5 EYEWITNESS NEWS reveal Kenya Gordon, 34, of New Hope is accused of working a second job while still logging hours as a PCA in the home of an unidentified couple in 2014 and 2015.

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According to a probable cause statement filed by the Attorney General's Medicaid Fraud Unit, Gordon "submitted over 200 instances of overlapping claims" between her work under PCA provider, A Caring Company, Inc. and Coram Healthcare.

In one quarter of a year, investigators say Gordon exceeded 1300 hours at both jobs. That would have required her to work more than 14 hours a day, every day, for three months.

A Caring Company, which is not accused of any crime, declined requests for an on-camera interview, but told 5 EYEWITNESS NEWS it has paid back all unauthorized money to the state and that Gordon is no longer associated with the agency.

"We had no idea that this person was working another job at the same time," said owner Cheri Bielke.

Bielke also said Gordon and her clients both came to her agency under the PCA Choice program which allows clients to select their own caregivers.

Gordon, who is scheduled to go to trial in July, did not answer at the address listed for her in court documents and her attorney did not return calls for comment.


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Executive director of the Minnesota Home Care Association, Kathy Messerli called any allegations of fraud "very troubling," but she and others also point to what they say is a larger problem facing the state – a shortage of qualified PCA's.

"We really are facing a crisis as far as serving people in their homes. There just aren't enough people," Messerli said.

The association, whose members include PCA providers, says about 43,000 people in Minnesota use PCA services in their homes. It cites a rising demand for services, low wages for PCA's, and insufficient reimbursement from the state for the problems many agencies have filling open positions.

"There's a high level of responsibility for a very low wage, so it's hard to recruit people to do those jobs when they can take on another job for the same wage or higher and have less responsibility," Messerli said. "We have clients out there waiting for services. They simply can't get the care they need."

The Minnesota Department of Human Services declined an interview request from 5 EYEWITNESS NEWS, but DHS provided the following statistics:

  • As of July 2018, 153,611 people were enrolled as PCAs in Minnesota Health Care Programs. Of those, 43,080 actually provided services during fiscal year 2018. 
  • Individual PCAs must also meet provider standards by enrolling as a Minnesota Health Care Programs provider, passing a criminal background study and satisfactorily completing required online training.
  • PCA services must be supervised by a qualified professional as defined in state statute.

Messerli says recent legislation authorized funding for the state to move forward with implementing the federally mandated Electronic Visit Verification (EVV) program to try to cut down on fraud and better document the services clients receive. 

Credits

Eric Rasmussen

(Copyright 2019 - KSTP-TV, LLC A Hubbard Broadcasting Company

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