Minnesota has terminated the billing privileges of thousands of Medicaid providers flagged as “high risk” for fraud after the Trump administration threatened to withhold $2 billion in Medicaid payments flowing to the state over mismanagement concerns.In order to release the funds, the cleanup of Minnesota’s Medicaid enrollment records was required by the U.S. Centers for Medicare and Medicaid Services as part of a corrective action plan meant to restore federal confidence in the state’s oversight of the safety net system. According to federal and state investigations, Minnesota allowed fraudsters to steal billions of dollars from its Medicaid-funded healthcare programs for years through sophisticated billing schemes.State oversight officials had until the end of May to examine nearly 5,600 service providers identified as susceptible to fraud, and the Minnesota Department of Human Services released the results of its review late last week.
Of the high-risk providers audited, such as adult daycare facilities and autism therapy centers, Minnesota DHS only revalidated about 2,000 enrollees (37%), allowing them to continue receiving reimbursements without interruption.
But more than three-fifths, or 61%, of the providers were disenrolled due to inaccurate or incomplete administrative paperwork, failed site visits, or owners of these businesses failing their background checks. Minnesota DHS removed an additional 111 providers because they had already stopped providing Medicaid services by the time of the review.
