Medical services in limbo for thousands of providers amid Minnesota fraud crisis

The Minnesota Department of Human Services is reexamining over 5,000 Medicaid service providers across the state in an effort to combat fraud. 

The federal government said it would pull $2 billion in annual Medicaid funding from Minnesota in January if the state didn't make changes.

The Minnesota Department of Human Services set out to revalidate thousands of providers in programs deemed high risk for fraud by asking providers to submit verification paperwork and making unannounced site visits. The deadline passed on Sunday. 

The latest data, published on May 27, shows 1,009 providers approved, 1,151 disenrolled and over 3,000 providers with pending applications. 

Paige Berland and Camille Heyman run Minnesota Behavioral Specialists, providing autism care to children through two locations in the metro area. The women say that after submitting their paperwork, they received letters from DHS with determinations for both locations: the Bloomington center was terminated and the Eagan office was approved. 

"It doesn't make sense, everything is the same minus the location," Berland said. "So why was one approved and one wasn't approved?"

The termination letter said the Bloomington center was denied because they failed to disclose a managing employee during a site visit. Berland disputes that and said she already submitted an appeal.

"We were told to keep running, keep continuing as we are while we go through this process," she said. "It just means that we don't have the money coming in." 

Josh Berg with Accessible Space says they're also in limbo. Berg said they offer integrated community supports, which means caretakers provide in-unit assistance for people with spinal cord injuries and disabilities. 

"Most of the folks that we support are wheelchair-bound," Berg said. "Helping with meals, helping with medications, helping them just live their lives."

Berg said that of the seven locations where people are housed, the Department of Human Services terminated five and approved two. He believes the timeline to conduct this revalidation process was too aggressive. He said Accessible Space has also submitted an appeal.

"We're not able to bill for services, we're not able to start new services for anybody or change any of the supports that they receive," he said. 

Both Berg and Berland say they agree fraud needs to be dealt with, but they hope Minnesotans who truly need services aren't left without the services they need. 

"Not just the clients rely on services, but the families do too, so we can't stop services; that's not an option on our plate," Berland said. "We want to continue to provide these services; they are medically necessary." 

The Minnesota Department of Human Services said a disenrollment letter could be sent for a few reasons, including failure to submit revalidation application after two notification attempts, failure to provide all requested documents within the required timeframe and failure to meet the criteria required during an on-site visit.

A spokesperson for the Department of Human Services said it's currently in the process of compiling data from the thousands of applications, but didn't say when the department would share those final numbers.