Billing Mistakes or Parent Pay Fraud in Minnesota?
In Minnesota, Consumer Directed Community Support (CDCS) Personal Assistant and Parent Pay are governed by Minnesota Statute 256B.0913. Personal assistance services are the only services for which a spouse or parent of a minor may be paid with consumer directed community supports (CDCS) funds. While a spouse or parent of a minor may also serve in other supportive roles (e.g., support planner, managing employer), the spouse/parent cannot be paid to serve in these roles or provide other supports.
What is Parent Pay Fraud In Minnesota?
In Minnesota, Parent Pay fraud is a crime often charges as Theft of Public Funds—a Felony. Parent Pay fraud is billing for Parent Pay for services that were not provided or services that were provided, but do not fall within services that qualify for Parent Pay.
Who Investigates Parent Pay Fraud?
Parent Pay fraud can be investigated by the County, as well as by the Minnesota Department of Human Services (DHS). DHS investigates Parent Pay fraud for program integrity activities and investigations to ensure taxpayer dollars are used reasonably and appropriately. If you are being contacted by DHS, you may be investigated even if you believe you did not do anything wrong.
If you are being investigated for Parent Pay fraud by anyone, including the County or the Minnesota Department of Human Services (MN DHS), talk with an attorney before you provide any statements or information.
Call (651) 468-2108 to speak with the experienced lawyers at RAM Law PLLC during a confidential free consultation if you believe you are under investigation.
What Are The Requirements For ADL Dependency?
To pay a spouse or parent of a minor for personal assistance services, the person receiving services must be assessed as dependent in at least one activity of daily living (ADL). The service or support must be necessary to meet at least one identified ADL dependency, which is determined based on the ADL items included in the assessment the person receives.
Any ADL dependency documented in the MnCHOICES/long-term care consultation (LTCC) assessment that meets the eligibility criteria for any program is valid for determining this ADL dependency requirement. The MnCHOICES assessment is a comprehensive, broad assessment that identifies ADL dependencies across several program areas. The assessment provides a way to:
1. Identify activities in which the person is dependent;
2. Distinguish between activities a spouse/parent would typically perform and activities that go beyond what a spouse/parent or family member would typically perform; and
3. Identify areas in which the level of assistance or supervision the person requires exceeds what is typically required for a person of the same age.
What Are The Requirements For A Parent Or Spouse Of A Minor To Be Paid For Personal Assistance Services?
The personal assistance services for which the spouse or parent of a minor is paid must:
1. Fall within the description and allowable costs of the personal assistance service category described on CDCS Manual – Personal assistance;
2. Be related to the person's disability or assessed needs;
3. Be necessary to meet at least one of the person's identified ADL dependencies, as described above; and
4. Not be an activity a spouse or parent of a minor would typically perform or be responsible to perform. These activities may include, but are not limited to, age-appropriate supervision, transportation of children or average household maintenance (e.g., house cleaning, meal preparation, laundry). The spouse or parent of a minor may be paid if they must assist the person with tasks beyond what is considered typical responsibility (e.g., doing additional laundry for a 12-year-old child who is incontinent)
The person's identified ADL dependency does not represent the only allowable activities for which a spouse or parent of a minor can be paid. The lead agency considers all of the person's assessed needs that are within the parameters of the personal assistance service category when it reviews the spouse’s or parent’s hours and duties. Other assessed needs may include supervision for health and safety or behavioral concerns beyond what is considered age-appropriate.
How Many Hours Per Week Can Be Billed For Parent Pay?
Community First Services and Support (CFSS) also will allow a person’s spouse or the parent of a minor to receive payment. When a spouse or parent of a minor receives payment to provide services, the service limits apply to the total combined hours from both CFSS and CDCS.
When a spouse or parent of minor provides personal assistance services, the following limitations apply.
One Parent
If only one parent provides personal assistance services to their minor child(ren), the parent may provide up to 60 hours of paid support in a seven-day period, regardless of the number of children they serve in the household who use CDCS or CFSS.
Multiple Parents
If more than one parent of a minor is paid to provide personal assistance services to their minor child(ren), each parent may provide up to 40 hours of paid support in any seven-day period, regardless of:
· The number of children in the household who use CDCS and/or CFSS.
· The number of households in which the child(ren) receive CDCS and/or CFSS services.
· The number of parents in the household(s).
· The actual number of hours of care each parent provides.
The total number of combined hours of CDCS/CFSS provided by all of the parents cannot exceed 80 hours in a seven-day period.
Spouse
If a person's spouse provides personal assistance services, the spouse may provide up to 60 hours of paid support in a seven-day period.
Spouse and Parent
A person cannot be paid for more than 60 hours in a seven-day period if the person provides personal assistance as both a paid spouse and a paid parent of a minor.
What Should I Do If I Am Being Investigated for Fraud?
Investigation into fraud is no joking matter. The Minnesota Department of Human Services (DHS) conducts program integrity activities and investigations to ensure taxpayer dollars are used reasonably and appropriately. If you are being contacted by DHS, you may be investigated even if you believe you did not do anything wrong.
Call (651) 468-2108 to speak with the experienced lawyers at RAM Law PLLC during a confidential free consultation if you believe you are under investigation.
Can I Be Charges With Committing Crime(s) For Parent Pay Billing Mistakes?
The short answer is no, but it often happens. Parent Pay fraud requires intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and knowing the deception violates the law or the public trust and could result in unauthorized personal benefit or benefit to others.
What should I do if I am Contacted by Minnesota Department of Human Services (DHS) or the Minnesota Office of Inspector General?
Intentionally overbilling by even $1 is a felony under Minnesota law, often criminally charged as Theft by False Representation Public Funds pursuant to Minnesota Statute 609.52. Intentionally overbilling by $1 can also be criminally charged as a Felony Theft by Swindle. These criminal charges can carry a maximum prison sentence of 20 years depending on the alleged dollar amount.
Because this is serious business, call the lawyers at RAM Law PLLC at (651) 468-2108 before you make any statements to anyone including employees and investigators of the Minnesota Department of Human Services (DHS) or the Minnesota Office of Inspector General (OIG). Anything you say can be used against you in criminal and civil court. For this reason, it is always wise to speak with an attorney if you have reason to believe you are under investigation.
How Important is Documentation for Parent Pay?
Documentation is everything when billing for Parent Pay. Accurate and sufficient documentation can be the difference between prison and a “thank you for the clarification.” The lead agency must clearly document the person’s service needs and identify outcomes in the person’s support plan. The Parent Pay Agency provider is responsible to provide written reports to the lead agency.
What Should I Do Now?
If you have questions about being questioned by anyone from the Minnesota DHS or OIG, do not wait, call (651) 468-2108 for a free confidential consultation with the attorneys at RAM Law PLLC.