Minnesota Gov. Tim Walz announced Wednesday that he has ordered a “third-party audit of billing for 14 high-risk Medicaid services” amid widespread fraud in state government.
The governor’s office said the Minnesota Department of Human Services (DHS) has contracted with Optum, which will analyze Medicaid fee-for-service claims data and flag potential issues for DHS review. Optum’s analytics will identify irregularities such as missing documentation, unusually high billing patterns, or inconsistencies suggesting that a claim may not meet program requirements.
DHS has designated 14 Medicaid services as high-risk “based on programmatic vulnerabilities, evidence of fraudulent activity, or data analytics that revealed potentially suspicious patterns, claim anomalies, or outliers.”
Payments for the 14 programs will be paused for up to 90 days until the audit is complete, Walz’s office said. The 14 services include: Early Intensive Developmental 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, and Housing Stabilization Services.
“We cannot effectively deliver programs and services if they don’t have the backing of the public’s trust. In order to restore that trust we are pumping the brakes on 14 programs that were created to help the most disadvantaged among us, yet have become the target of criminal activity,” Walz said in a press release.
His office said claims flagged by Optum will be verified by DHS to confirm whether services were provided as billed. Claims suspected to be improper will be referred to the agency’s Office of Inspector General for review and possible investigation.
Assistant U.S. Attorney Joe Thompson previously said the level of Medicaid fraud in Minnesota is “staggering.”
“Unfortunately, our system of trust but verify no longer works. These programs have been abused over and over to the point where the fraud has overtaken the legitimate services,” he said in September when announcing charges against eight individuals for their alleged role in defrauding the state’s Housing Stabilization Services program, which the state has now moved to shut down.
Thompson also announced charges last month against a woman who allegedly defrauded the Early Intensive Developmental and Behavioral Intervention program.
Legislators react
Minnesota House Speaker Lisa Demuth, R-Cold Spring, and Floor Leader Harry Niska, R-Ramsey, released a joint statement reacting to Walz’s announcement.
“It is shocking to learn that the Walz Administration has only now identified 14 programs as high risk for Medicaid fraud. Minnesotans have watched scandal after scandal unfold under Governor Walz, but the fact that there are more than a dozen programs under suspicion proves that Walz’s fraud crisis is far worse, and far more widespread, than anyone was led to believe by the administration,” they said.
“Independent audits are essential to uncovering and stopping fraud in Minnesota, and while it’s encouraging to see another tool being utilized to combat the explosion of fraud on Walz’s watch, we still must pass legislation next session to create a Legislative Office of the Inspector General to deliver real accountability and transparency in state government.”
Senate Minority Leader Mark Johnson, R-East Grand Forks, said the third-party audit is “too little, too late, and too desperate from a Governor who has no real track record in protecting the integrity of programs designed to help those in need.”
“Republicans supported serious fraud prevention measures to stop the fraud before it started, but we were blocked and thwarted at every step by the Walz administration.”
Anthony Gockowski
Anthony Gockowski is Editor-in-Chief of Alpha News. He previously worked as an editor for The Minnesota Sun and Campus Reform, and wrote for the Daily Caller.
