Minnesota watchdog urges stronger safeguards against Medicaid fraud
Minnesota's legislative watchdog is urging state lawmakers to strengthen oversight of Medicaid-funded services after a review found vulnerabilities that could lead to fraud, waste and abuse.
The recommendations come from the Minnesota Office of the Legislative Auditor's summary of an Optum assessment that examined 14 human services programs identified by the state as high risk. The assessment looked for weaknesses that could lead to improper payments and opportunities for fraud.
"The thing that stood out is there is a lot of work to do both for the agency and also for the Legislature," OLA Legislative Auditor Judy Randall said.
According to the summary released Thursday, Optum identified vulnerabilities involving eligibility requirements, billing and coding practices, provider oversight and information technology controls. The report said weaknesses in those areas could increase the risk of improper payments or exploitation of state-funded programs.
Based on its review, the Office of the Legislative Auditor recommended stronger fraud detection efforts, clearer program requirements and enhanced technology systems capable of identifying suspicious billing patterns before payments are made.
"That's something that we brought into the summary, is to identify and highlight opportunities where the Legislature can help to strengthen programs and therefore help strengthen oversight," Randall said.
In a response included with the report, DHS said many claims initially flagged by Optum were later determined not to be problematic after the analytics were refined to better reflect program policies.
"It is also important to note that a flag for review is not a finding of fraud, waste, or abuse," Temporary Commissioner John Connolly wrote.
DHS said it is continuing work to develop a long-term strategy aimed at strengthening payment integrity and reducing improper payments.
"The hope is that the legislature takes those under consideration and helps to clarify some programs and work with DHS to tighten this up," she said.
The auditor's office emphasized that it did not independently verify Optum's findings and said its summary should not be interpreted as an endorsement of the company's conclusions or recommendations.
