An Eden Prairie woman who operates a chain of Chinese acupuncture clinics across the Twin Cities metro is accused of conspiring with others in a fraudulent Medicaid billing scheme involving interpreter services for Somali patients, according to a criminal complaint filed in Hennepin County.
Xiaoyan Hu, 58, who operates Chinese Acupuncture & Herb Center, Inc., has been charged with five felony counts of aiding and abetting theft by false representation involving the billing scheme that resulted in overpayments of over $59,000 between Jan. 2015 and June 2017. According to the complaint, Hu conspired with Isha Mohamed, an interpreter employed by ARCH Language Network, to falsify records that resulted in the overpayments to Mohamed.
According to the center’s website, it operates clinics in Edina, Burnsville, St. Paul and Minneapolis.
An investigator with the Minnesota Medicaid Fraud Control Unit (MFCU) of the Minnesota Attorney General’s Office explained in the complaint that Medicaid covers language interpretation services when interpretation is required to receive adequate medical services. Individual interpreters, such as Mohamed, are required to fill out documents known as interpreter logs and submit the logs to their employers to verify that a service has been provided. The interpreter’s employer then uses those logs to submit claims for reimbursement from Medicaid. In this case, the payments were managed through UCare, a managed-care organization that contracts with the Department of Human Services (DHS) to provide payments to providers in a managed-care model.
The scheme, described in the complaint as an “interpreter stacking scheme,” involves recording interpreter appointments at 90-minute gaps throughout the day to maximize reimbursement from UCare under its “first appointment rule” which allows billing of full hours of service as opposed to partial hours of service had the appointments been accurately recorded at less than 90-minute intervals.
The complaint detailed that interpreter services are reimbursed on a 15-minute-unit basis. UCare’s reimbursement policy reimburses an interpreter’s first appointment of the day at the rate of an entire hour, as long as at least one 15-minute-unit was completed. UCare’s “first appointment” rule resets after a 90-minute period, so interpreters can have multiple “first appointments” throughout a single day. The accuracy of the interpreter logs is verified by clinical staff, therefore a stacking scheme relies on either forging a signature or complicity from clinical staff, the complaint said.
The investigator stated in the complaint that interpreter stacking schemes are among the most common fraud schemes involving interpreter claims.
STACKING AT CHINESE ACUPUNCTURE & HERB CENTER
The complaint states that Chinese Acupuncture & Herb Center provides acupuncture services to Medicaid recipients, including recipients receiving managed care through UCare. Chinese Acupuncture regularly provides services to Somali patients who require both transportation services to and interpreter services at the Chinese Acupuncture clinics. Chinese Acupuncture staff sign interpreter logs for interpreter services performed at Chinese Acupuncture clinics.
The complaint further states that Isha Mohamed was responsible for arranging transportation for groups of Medicaid recipients for appointments at Chinese Acupuncture, and that she subsequently completed interpreter logs claiming to have provided multiple hours of interpreter services at these appointments.
According to the complaint, Mohamed engaged in a prolonged and extensive stacking scheme while providing interpreter services at Chinese Acupuncture, made possible through Hu’s actions and through Hu’s direction of other Chinese Acupuncture staff. Mohamed’s interpreter logs claimed that interpreter services were rendered at least 90-minutes apart, however, the investigator found that clinic appointment time records did not match the times that Mohamed claimed, resulting in the overbilling to Medicaid.
One example detailed in the complaint stated that Hu signed Mohamed’s interpreter logs indicating that the interpreter services occurred during four appointments on a given date at least 90-minutes apart between 9 a.m. and 5:30 p.m. However, the appointment times in Chinese Acupuncture’s records indicated that all four appointments occurred over a period of less than two hours from 11 a.m. to 12:45 p.m., which would not have accommodated the 90-minute appointment gap rule.
Had the interpreter logs matched Chinese Acupuncture’s records, Mohamed would have been eligible for, at most, reimbursement for 1.75 hours of interpreting. Mohamed’s stacking, however, permitted her to collect over double the maximum to which she was entitled.
The complaint also stated that Hu’s involvement in the falsification of the interpreter logs enabled fraud other than stacking schemes, including billing for services with no corresponding medical appointment, and billing for services whose timing overlapped with Mohamed’s other job as a PCA (personal care assistant).
The complaint states that from Oct. 31, 2014, Mohamed obtained for herself or a third party over $77,000 via submission of interpreter logs and claims for reimbursement to UCare through her employer. Of that $77,000, the investigator identified that $59,675 was fraudulently obtained through the aiding and abetting of Hu during the period of Jan. 1, 2015 through June 30, 2017.
Hu not only signed some of Mohamed’s interpreter logs, the complaint states, but also instructed other employees of Chinese Acupuncture to enable Mohamed’s stacking. Former employees of Chinese Acupuncture, identified in the complaint as “A.P., A.K., and D.P.,” all told MFCU investigators that they were instructed by Hu to sign blank or falsified interpreter logs.
The complaint does not detail Hu’s motivation for participating in the scheme or whether she may have received kickbacks or some other incentive as a result of the overpayments to Mohamed.
Hu was booked into Hennepin County Jail on Jan. 15 and was released the next day with no bail required, according to the jail record. The court record shows that Hu requested and was granted an interpreter and that she is scheduled to make her first court appearance on the charges on Jan. 21. An attorney is not yet listed for Hu.
The complaint states that the penalty if convicted could be up to 10 years in prison and/or a $20,000 fine on three of the counts and up to 5 years and/or a $10,000 fine on the other two counts.
Inquiries regarding potential charges against Isha Mohamed to the Attorney General’s Office and the Hennepin County Attorney’s Office were not immediately returned. Requests for comments from ARCH Language Network and Chinese Acupuncture & Herb Center, Inc., were not responded to prior to publication.
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