A preliminary analysis of Minnesota’s Medicaid payouts found that direct policy violations may have cost the state more than $52 million in less than four years. But the findings come with big caveats.
The $52 million figure does not imply that fraud occurred, but points to claims where policy wasn’t followed for some reason, including providers filing claims improperly, said Minnesota Medicaid Director John Connolly.
The report also said Minnesota could save upwards of $1.7 billion if it closes gaps in its Medicaid policies. Those gaps and other vulnerabilities discovered in the analysis were redacted.
“We don't want to share information with bad actors — with fraudsters — that will tip them off to how we're looking at fraud and looking at risk or vulnerability to fraud,” Connolly said Friday in a call with reporters. “So the last thing we want to do in this process is to provide information that helps people steal from the Minnesota taxpayer.”
In December, federal prosecutors announced a slate of additional charges tied to alleged widespread fraud in Minnesota’s Medicaid programs. And they suggested that since 2018, fraudsters had received roughly $9 billion through 14 Medicaid programs viewed as high risk for abuse.
The new analysis of Medicaid payouts was done by Optum, a business unit within UnitedHealthGroup. The state began working with Optum to pre-screen new claims and study the state’s past payouts to find vulnerabilities.
“The prior, kind of tip-based way that we investigated fraud or potential program integrity concerns, it just wasn't up to the task,” Connelly said.
Connelly said the report will also help the state’s Department of Human Services investigate current claims before money is doled out for 14 programs that have a high risk of fraud.
He added that it's a preliminary analysis, and the data doesn’t support the $9 billion in fraud alleged by the U.S. Attorney’s Office.
“We don't yet have a number, so we don't know that to be true, and numbers that are placed out there at this point are speculative, because investigations are continuing,” he said.
He added that his office is sending its information to the U.S. Attorney’s Office in Minnesota, but due to the slew of recent resignations there, he’s not sure who’s receiving it.