Minnesota Pauses Medicaid Payments for Fraud Review

St. Paul, MN (MinnesotaNow) - Governor Tim Walz has announced a third-party audit of 14 “high-risk” Medicaid services in Minnesota.

A news release issued by his office today says payments for the affected programs will be paused for up to three months while an audit is conducted to identify “suspicious billing activity and scrutinize the use of public funds.” The Minnesota Department of Human Services has contracted with the firm Optum to conduct the audits and flag potential issues for review by the state agency.

14 Medicaid Services Flagged for High-Risk Oversight

According to the statement, the Department of Human Services designated the affected Medicaid services based on “programmatic vulnerabilities, evidence of fraudulent activity, or data analytics that revealed potentially suspicious patterns, claim anomalies, or outliers.”

The list includes:

• Early Intensive Development and Behavioral Intervention services for autism

• Integrated Community Supports

• Nonemergency Medical Transportation

• Peer Recovery Services

• Adult Rehabilitative Mental Health Services

• Adult Day Services

• Personal Care Assistance/Community First Services and Supports

• Recuperative Care

• Individualized Home Supports

• Adult Companion Services

• Night Supervision

• Assertive Community Treatment

• Intensive Residential Treatment Services

• Housing Stabilization Services (previously terminated due to fraudulent activity)
  

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New Safeguards Include Background Checks and Site Visits

The news release says the services deemed high risk will also be subject to stricter oversight requirements. These include mandated enhanced fingerprint background studies for owners of provider agencies, initial screening visits, and unannounced site visits. It goes on to state that the new layer of review will help safeguard Medicaid dollars before payments are issued.

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