From KSTP.com: 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.
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.
Optum estimates more than $1.7 billion in Medicaid payments need to be reviewed for potential fraud.
The report notes that the Minnesota DHS paid Optum a $2 million fee to help find the loopholes in the state’s payment system in order to stop the fraud.
READ MORE and view the Optum reports at KSTP.com.
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