In an effort to combat Medicaid fraud, an urgent statewide initiative is underway to protect funding.
“Fraud, fraud, fraud, in Minnesota, there’s this cloud hanging over all of our services,” said James Clark, inspector general for the Minnesota Department of Human Services.
According to federal prosecutors, about $9 billion, or roughly half of the $20.3 billion spent on high-risk Medicaid programs in Minnesota since 2018, may have been fraudulent.
“We know that greedy people and businesses have learned how to exploit our programs, but we also know quality legit services are being provided here, and a lot of these businesses, their professional reputations have been harmed by all the fraud allegations when they had nothing to do with this stuff,” Clark explained.
In order to separate the bad from the good moving forward, DHS has enlisted a program called Minnesota Revalidate. “It’s called revalidation, but really it’s a reenrollment,” said Clark.
The goal is to make sure all 5,500 providers of high-risk Medicaid services in Minnesota are fully compliant. This means providers must show they have valid paperwork, training credentials, and insurance as part of their revalidation application that must be completed and submitted by May 31, 2026.
“We normally do this every couple of years,” Clark explained. “But we’ve been required to do this, given the pressures we’re facing, over the course of three months. So, it’s urgent; there’s a quick turnaround.”
The 13 high-risk Medicaid services subject to revalidation in Minnesota are:
- Adult Companion Care
- Adult Day Services
- Adult Rehabilitative Mental Health Services
- Assertive Community Treatment
- Community First Services and Supports and Personal Care agencies
- Early Intensive Developmental and Behavioral Intervention agencies
- Individualized Home Supports
- Integrated Community Supports
- Intensive Residential Treatment Services
- Peer Recovery
- Night Supervision
- Non-Emergency Medical Transportation
- Recuperative Care
Once providers complete and submit an application, DHS will show up unannounced.
“We say, ‘hey, we see you’re reenrolling, and you’ve provided us all of this information, we want to ask you some questions to verify the information you provided us is correct,’” Clark explained.
He added that providers will be asked questions to ensure they are who they say they are, qualified, credentialed, insured, and located where they say they are.
It is a detailed process, but Clark said it’s important. Providers who do not revalidate will be terminated, disenrolled, and unable to bill the state for services. “In layman’s terms, we kick you out as a Medicaid provider in Minnesota.”
Clark added there is an appeals process for those who are a “day late and a dollar short” on their paperwork, but emphasized the importance of understanding and abiding by the process, not only for the providers, but also for their clients who need services. The fallout would be felt by many.
“We’re talking wait lists, disruptions to services,” Clark said. “These are folks that thought they were getting services, and all of a sudden the money’s getting turned off, and their provider is saying I can no longer help you. We want to avoid that.”
Providers can review all the details involved in Minnesota Revalidate here, or call the resources center at: 651-431-2700 or 800-366-5411.
There is a two-day training on May 13 and May 14, which will help providers ensure they know how to bill properly for services, a requirement of Minnesota Revalidate. Learn more here.
