The Minnesota Department of Human Services (DHS) announced Wednesday that it would resume payments to disenrolled Medicaid providers in “high-risk” state programs if those providers submitted paperwork appealing their disenrollment.
Earlier this month, DHS announced it completed its review of 5,583 businesses and other organization that are enrolled as Medicaid providers in 13 state-run welfare programs. Those 13 programs have been deemed “high-risk” due to their vulnerability to fraud.
The state government’s review of those Medicaid providers, which was called Revalidate 2026, was required by the federal government in response to ongoing fraud in Minnesota’s state-run, Medicaid-funded welfare programs.
As part of the revalidation process, DHS examined provider documents, reviewed billing practices, and conducted provider site visits. Medicaid providers are reimbursed by the state in exchange for providing eligible welfare services to certain populations.
In total, 3,411 Medicaid providers in the “high-risk” programs were disenrolled for various reasons including “submission of incomplete paperwork and documentation” and failed site visits. This meant over 60% of those “high-risk” providers were disenrolled.
However, Alpha News has learned that a majority of the disenrolled Medicaid providers are now appealing their disenrollment. According to DHS, 2,250 providers have appealed as of June 11. That means roughly 66% of disenrolled providers are appealing.
On Wednesday, DHS published a news bulletin which said that any disenrolled provider that submits an appeal by June 9 will have their payment suspension lifted. The bulletin cited “continuity of care” as the reason for resuming payments.
In a statement to Alpha News, DHS said it has been “informing providers and provider associations that if their paperwork is submitted for an appeal, we can reinstate their ability to bill for continuity of care purposes while the appeals process is ongoing.”
“We don’t want to harm legitimate providers,” the statement continued. “We care deeply that vulnerable Minnesotans are getting the care they need from trusted providers. We also have to make sure that providers are meeting legal requirements to provide services.”
Since DHS began disenrolling Medicaid providers from “high-risk” programs, providers have expressed concerns that legitimate Medicaid providers are being caught up in the process.
Earlier this week, a Milaca-area Medicaid provider told Alpha News that her company was disenrolled despite being a legitimate provider. That provider said she believes her business was disenrolled after a state worker confused two businesses owned by the provider.
Another provider told Alpha News that his medical transportation company was disenrolled due to a minor staffing issue that could have been resolved with a phone call. His business transports people who need dialysis, chemotherapy, and other appointments.
In Minnesota, federal authorities have brought criminal charges against people who have allegedly defrauded the “high-risk” programs. Schemes used to defraud those programs often involve an illegitimate provider billing the state for services that were not provided.
Republican State Rep. Natalie Zeleznikar has been particularly vocal on this issue.
In a video message, Zeleznikar said “we all want the sham companies removed,” but many providers were automatically disenrolled because DHS did not have enough time to review those providers before the June 1 deadline to complete the revalidation process.
Alpha News asked DHS about this late Friday but did not receive a response.
“Just because [the providers] were terminated, doesn’t mean they’re the fraudsters,” Zeleznikar said.
Luke Sprinkel
Luke Sprinkel previously worked as a Legislative Assistant at the Minnesota House of Representatives. He grew up as a Missionary Kid (MK) living in England, Thailand, Tanzania, and the Middle East. Luke graduated from Regent University in 2018.
