MN fraud: Minnesota DHS notifies 3,400+ Medicaid providers they face removal
MN Medicaid deadline: Providers see funding cutoff
A rushed Medicaid review has left thousands of Minnesota care providers suddenly without funding, putting essential services, vulnerable patients, and jobs at risk. The sudden Medicaid cutoff comes after the federal government withheld $2 billion over fraud concerns, forcing the state to evaluate about 5,500 providers in high-risk programs in just five months.
ST. PAUL, Minn. (FOX 9) - The Minnesota Department of Human Services has notified more than 3,400 providers that they will be removed from Minnesota's health care programs after a massive revalidation effort as the state battles with the federal government over $2 billion in funding.
"Minnesota Revalidate"
The backstory:
Since January, the state has gone through the process of revalidating 5,583 Medicaid providers in "high-risk programs." Providers were required to provide the information they gave when they first became providers. The state says they made multiple attempts to contact each provider, including three written attempts and multiple follow-up calls.
Providers had to provide basic ownership disclosures, current licenses, prove they had enough workers, and provide fingerprints for owners. The state would also conduct unannounced site visits at the facilities.
The effort came as the state was under fire from the federal government over its oversight of the state's Medicaid program for fraud. At the time, the federal Centers for Medicare and Medicaid Services had moved to withhold $2 billion in Medicaid funding from the state. As of Thursday, that money remains up in the air.
Sunday was the deadline for the state to complete the revalidation.
Thousands of providers removed
What we know:
Thursday morning, the Minnesota Department of Human Services announced the results of the revalidation effort.
Of the 5,583 providers reviewed, officials said only 2,061 were successfully revalidated. A total of 3,411 providers have been notified they are due to be removed as providers, according to DHS.
Of those providers, the state say they are facing removal due to:
- 2,491 providers are facing disenrollment due to incomplete paperwork and documentation.
- 916 providers face disenrollment due to failed verification or site visits
- 4 providers face disenrollment due to failed background study
The state says another 111 providers were removed from the review because they are no longer providing "high-risk" Medicaid services.
Then an additional 59 providers have been referred to the Office of the Inspector General for further review. The inspector general would be the authority to investigate potential fraud cases.
Big picture view:
Officials said the common reasons for disenrollment notices were:
- failure to disclose management authority
- failure to report change in ownership
- failure to report changes in or maintain proper credentials such as liability and surety bonds
- failure to provide access
- incomplete applications.
What they're saying:
In a provided statement, Minnesota DHS Deputy Commissioner Shireen Gandhi said:
"More than 1 million Minnesotans deserve to have confidence and trust in the Medicaid providers they depend on for lifesaving and life-affirming care. We are grateful to the providers who successfully completed the revalidation process and will continue to provide quality care."
A rushed review
Dig deeper:
The Department of Human Services had just five months to review all 5,583 Medicaid providers across the state.
Providers say the rushed review has left many legitimate providers caught up in the net. FOX 9 spoke with Susan Holman of Legacy Place Assisted Living in Sauk Rapids, who learned she had been disenrolled without any clear explanation.
Meghann Lewis and Codi Warnecke, who run Bella Mente Home Care and Heart & Hara Home Care, said they received a message telling them they had been revalidated, then an hour later informing them their funding had been suspended.
Both businesses are appealing the decisions and are considering lawsuits.
What's next:
Providers do have 60 days to appeal the notices. If a provider appeals and submits the needed documentation, the state may reinstate the provider.
It's unclear how the completion of the revalidation effort will impact the $2 billion in funding. FOX 9 has reached out to federal authorities to see if they plan to release any funds as a result of the effort.
Attorney General Keith Ellison filed a lawsuit over the federal government pulling those funds. A mutual stay has been granted in that lawsuit to give the state and the feds time to negotiate a resolution. The court granted a 120-day pause in the case and is asking for an update by early September.