Minnesota’s Department of Human Services (DHS) released a new report Friday that was provided by an outside consultant, which examined Medicaid system billing over four years and raised concerns with how taxpayer money was paid out.
“Optum has identified recurring vulnerabilities across all high-risk services flagged by Minnesota DHS. These vulnerabilities stem from weaknesses in monitoring, auditing, and inter-agency communication, which undermine program integrity. Such gaps can result in beneficiary harm, improper payments, eligibility errors, or intentional fraud, waste, and abuse,” according to the report provided by the consultant, Optum.
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The report identified $52.3 million in Medicaid payments from 14 programs over the last 4 years that did not meet DHS policies/procedures and should be recovered.
DHS identified 14 programs deemed “high-risk” for review 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.
The report estimates more than $1.7 billion in Medicaid payments that need a closer look to see if there were possible issues, including whether there were appropriate claims for service.
“I think this is a step in recognizing that we needed more, that we have gaps that we have to deal with; this is really a key step in closing those gaps,” said John Connolly, Minnesota DHS deputy commissioner and state Medicaid director.
DHS paid the private firm, Optum, $2 million to help find holes in the state’s payment system as they try to spot and stop fraud and develop and automate a system to review fee-for-service Medicaid claims before they are paid to look for possible issues.
“These figures are not evidence of fraud, waste or abuse,” a DHS spokesperson later wrote to 5 EYEWITNESS NEWS. “In the interest of transparency, we shared the information in the report as soon as it was available for release, but that also means we need more time to review its results.”
Deputy Commissioner Connolly was asked Friday during a briefing why DHS wasn’t able to spot problems with the system sooner, when it took a consultant three months.
“We did not have tools, I think, up to the task to responding to the increasingly complex fraud schemes that we have been grappling with, particularly in the last year or so,” Connolly said.
DHS estimates it will take upwards of 9 months to fine-tune the new Medicaid payment program.
You can view the reports below. The blacked-out text was redacted by Minnesota DHS.
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