Apple Valley Woman Sentenced for Defrauding a Home Health Care Company and Medica

MINNEAPOLIS—Earlier today in federal court, an Apple Valley woman was sentenced for defrauding both her employer and Medica. United States District Court Judge David S. Doty sentenced Lori Jo Mueller, age 48, to 51 months on one count of wire fraud and one count of health care fraud in connection to the crime. Mueller was charged on January 9, 2013, and pleaded guilty on February 4, 2013. In her plea agreement, Mueller admitted that from June 2006 through June 2012, she embezzled approximately $840,000 from Edelweiss Home Health Care, using the funds for her personal use.

Mueller began working for Edelweiss, which is located in Maple Grove, in 2002, and she was ultimately promoted to the position of vice president of operations. In that capacity, she was responsible for the review and payment of corporate invoices, bookkeeping, and other financial matters. Mueller admitted using her access to the corporate checking account to issue payments to herself. She also concealed her actions from the company owners and made misrepresentations concerning the company’s financial state.

In addition, from March 2010 through June 2012, Mueller defrauded Medica, a non-profit corporation that provides health insurance products to individuals and families. She administered claims submitted to various insurers seeking reimbursement for services provided by Edelweiss nursing staff. In some instances, Mueller double-billed by allowing claims for the same services to multiple insurance providers. For example, Mueller allowed both Minnesota Medicaid and Medica to be billed for identical services provided to one client. The particular double-billing resulted in a double-payment to Edelweiss with Medicaid being the proper payer and Medica being the overpayer. As a result of this criminal behavior, Mueller defrauded Medica of over $600,000.

This case was the result of an investigation by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services-Office of Inspector General (DHHS-OIG), and Minnesota Attorney General’s Medicaid Fraud Control Unit. It was prosecuted by Assistant U.S. Attorney David M. Genrich.

The U.S. Attorney’s Office participates in a task force with the Medicaid Fraud Control Unit at the Minnesota Attorney General’s Office that focuses on home health care fraud trends. The task force includes the DHHS-OIG, the FBI, the Internal Revenue Service, and other federal, state, and local law enforcement partners.

As a result of federal convictions for health care fraud, defendants are excluded from participating in federal health benefit programs, including Medicare and Medicaid. Exclusion determinations are made by the U.S. Department of Health and Human Services. Nationwide, more than 3,000 individuals were excluded from program participation in fiscal year 2010 based upon criminal convictions or patient abuse or neglect, license revocations, or other factors.

For more information, visit http://www.stopmedicarefraud.gov/or http://www.stopfraud.gov/protect-health.html.