More than 50% of providers enrolled in “high-risk” state-run, Medicaid-funded programs have been disenrolled since February, according to new figures from the Minnesota Department of Human Services (DHS).
Earlier this year, federal authorities threatened to withhold Medicaid funds from Minnesota if the state failed to address fraud in state programs. In turn, Minnesota agreed to review every provider in 13 state programs designated as being at “high-risk” for fraud.
That process began in February of this year and is called “Revalidate 2026.” In short, DHS is examining over 5,800 providers in just a few months. Medicaid providers are businesses that receive Medicaid funds in exchange for providing eligible program services.
DHS is examining provider documents, reviewing billing, and conducting provider site visits as part of the process. In a February statement, DHS said it would be “reexamining and revalidating over 5,800 Medicaid providers before this summer.”
The state agency previously asked other government agencies to collectively find and send over 168 other state employees who could assist with Revalidate 2026.
In April, Alpha News reported that 546 providers had completed the revalidation process and been approved. However, 405 providers had been disenrolled at that time. That meant 42.5% of all providers that completed the process at that time had been disenrolled.
Now, DHS has published updated figures which shows the share of disenrolled providers has increased.
According to DHS figures from May 27, 1,009 Medicaid providers in “high-risk” programs have been approved by DHS since revalidation began. However, 1,049 other providers have been disenrolled. Another 102 providers were disenrolled “due to inactivity.”
That means approximately 53% of providers that completed the revalidation process have been disenrolled.
DHS reports that the remaining 3,352 Medicaid providers in “high-risk” programs are in various pending stages of revalidation. For example, 1,767 providers are “in screening process” while another 853 are listed as “additional information needed.”
The 13 “high-risk” programs have come under significant scrutiny in recent months. A 14th “high-risk” program called the Housing Stabilization Services (HSS) program used to exist, but DHS shut down that program because it was overrun with fraud.
Last year, the U.S. Attorney’s Office estimated that $9 billion could have been stolen from those 14 “high-risk” programs since 2018. Just last month, federal authorities charged over a dozen people with defrauding those state-run programs.
Schemes used to defraud the “high-risk” programs often involve a bogus company or organization submitting fraudulent reimbursements to the state.
DHS said it sends disenrollment notifications for: “Failure to submit revalidation application after two notification attempts. Failure to provide all requested documents within required timeframe,” and “Failure to meet the criteria required during an on-site visit.”
The federal government instructed DHS to revalidate all providers in “high-risk” state programs by May 31. DHS told Alpha News that it is “currently in the process of compiling topline data from the paperwork we received as the deadline closed on Sunday, May 31.”
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.
