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Jennifer Amundson
651-431-5692
[email protected]
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New federal data released by the U.S. Centers for Medicare & Medicaid Services (CMS) shows the overall rate of improper payment in Minnesota’s Medicaid program is far below national averages.
In the review released this week, CMS found an error rate of slightly over 2.1%, compared to a national average of 6.1%. The data for the review was compiled before the Minnesota Department of Human Services began implementing new strategies to minimize the risk of fraud and harden its systems against bad actors. Reviewers at CMS checked billing statements and then compared them with medical records to ensure the billing was accurate.
“No amount of error or fraud is acceptable. Even one dollar is too much,” said Temporary Human Services Commissioner Shireen Gandhi. “We’re committed to making Minnesota a national model for preventing fraud and catching errors. This review shows we have strong internal controls that we continue to improve, and we are not stopping there as we accelerate our efforts to fight fraud.”
Since the fall of 2024, the Minnesota Human Services Department has introduced new processes and reforms to detect and prevent fraud:
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Identifying 14 high-risk services and establishing a Medicaid program integrity webpage for the public
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Auditing autism service providers, including on-site visits
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Discontinuing the Housing Stabilization Services program
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Establishing a moratorium on adding new service providers in 14 high-risk services
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Implementing licensure for autism centers
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Disenrolling inactive providers
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Beginning enhanced pre-payment review before fee-for-service payments are made to providers in the 14 high-risk services
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Developing plans to review and revalidate providers in the 14 high-risk services
The new federal report is the first hard data in the past year to identify the scope of improper payments in Minnesota’s Medicaid program. CMS provides ongoing reviews to comply with a law passed by Congress in 2019. Minnesota officials say the review is just one more tool they will use to ensure the integrity of the programs the state uses to administer benefits.
“The CMS review confirms DHS is doing better than the national average in complying with Medicaid payment requirements. And in our ongoing effort to reduce errors and strengthen program integrity, the state is bringing on independent consultants to double-check payments, audit processes and recommend changes going forward,” said Gandhi.
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