Minnesota Takes Steps To Combat Medicaid Fraud This Year

ST. PAUL (WJON News) -- The Minnesota Department of Human Services is launching "Minnesota Revalidate", a new initiative to combat Medicaid fraud in the state.

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Deputy Commissioner John Connolly says they plan to revalidate every one of the more than 5,800 Medicaid providers in the 13 high-risk programs by the end of May.

This involves a few things. First, reviewing providers' documentation. Second, reviewing the owners' background studies. Third, visiting these providers for on-site screenings. And 4th, conducting screening reviews before and after visiting the providers

DHS says it needs 168 state employees to perform those unannounced site visits.

We need 168 people from across the state to come into DHS and help us perform unannounced site visits. Training for this work will begin in February and inspections will start soon afterward. Providers in all 87 Minnesota counties will get unannounced visits as a part of this

Connolly says they've been working with the U.S. Centers for Medicare & Medicaid Services to avoid losing up to $2 billion in federal Medicaid funding.

We're particularly concerned that CMS did not conduct a recent audit to support this decision. It relied on off-topic and out-of-date reports from 2017 to 2021. Those reports are not relevant to the issues currently facing our program and our state. Additionally, there are no facts to support withholding all funds from 14 programs

A review released this month by CMS of improper Medicaid payments found that Minnesota’s error rate is well below the national average. The agency reviewed billing and then compared payments to medical records for actual services that were performed. An error rate of 2.1% was found, well below the national average of 6.1%.