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Looking at Minnesota autism fraud scheme
Moderator Blois Olson joins FOX 9 All Day to discuss the latest multimillion-dollar fraud scheme uncovered in Minnesota, which targets the state’s autism program.
ST. PAUL, Minn. (FOX 9) - Governor Tim Walz has ordered a third-party review of Medicaid billing through the state's Department of Human Services as two major fraud investigations are underway. At the same time, the state is pausing payments for some services while the audit is underway.
Medicaid billing audit in MN
What we know:
The governor's office announced it would move forward with a third-party audit of Medicaid billing through the Department of Human Services.
The audit will be performed by Optum, which will review claims and flag potential issues for DHS to follow up on. Optum will look for improper claims, missing documentation, high billing patterns, and other inconsistencies, a release from the governor's office states.
Governor Walz has also ordered a pause for payments to 14 DHS services, including: 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.
What's next:
The state says claims flagged by Optum will be checked by DHS and suspected improper claims will be referred to the Office of Inspector General for an investigation.
Fraud cases in Minnesota
The backstory:
The audit comes as the U.S. Attorney's Office has announced charges in a massive Minnesota Housing Stabilization program fraud scheme and a scheme targeting a state program to help those on the autism spectrum.
Both fraud cases come on the heels of the massive investigation and criminal case into Feeding Our Future, an organization that bilked more than $250 million from a USDA and Minnesota Department of Education program to feed school children during the COVID-19 pandemic. The investigation into Feeding Our Future led federal prosecutors to uncover some of the other fraud.
The state has already identified 14 Medicaid services it deems at high-risk based on "programmatic vulnerabilities."
What they're saying:
"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," Governor Walz said in a provided statement. "If you attempt to defraud our public programs and steal taxpayer dollars out from under the people who need them most – you will be stopped, and you will be held accountable."
Republican lawmakers, however, criticized the government for slow action, saying the audit is "too little, too late."
"Minnesotans are tired of after-action reports and audits," Senator Mark Johnson said in a statement. "They want prevention and accountability. 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. This 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."