Minnesota’s Department of Human Services completed a sweeping revalidation effort on high-risk Medicaid service providers, with results released Thursday, June 4. The state agency disenrolled more than half of the providers reviewed as part of a corrective action plan ordered by the federal Centers for Medicare & Medicaid Services. Deputy Commissioner Shireen Gandhi stated: “More than 1 million Minnesotans deserve to have confidence and trust in the Medicaid providers they depend on for lifesaving and life-affirming care.”
Scale and Results of the Initiative
The initiative involved on-site visits to 5,583 organizations across 13 categories deemed high-risk for Medicaid fraud, waste and abuse, including adult day services, autism care providers, and nonemergency medical transport services. Of those reviewed, DHS removed 111 organizations from consideration due to no longer providing a high-risk service, and referred 59 to the department’s Office of Inspector General for further review. DHS successfully revalidated 2,061 programs that can continue billing Medicaid, while 3,411 providers—61% of the revalidation pool—were disenrolled.
Reasons for Disenrollment
The reasons for disenrollment varied: 2,491 providers had incomplete paperwork and documentation, while 916 were disenrolled due to failed verification during site visits. Four additional providers failed background studies. Gandhi emphasized the importance of documentation: “The paperwork is a critical step. This is just not checking the box. DHS uses the information to check requirements are met. And when we go on site, what we see must match what was submitted to us.”
Appeals and Provider Support
Affected providers have 60 days to appeal their disenrollments. DHS has created a webpage to help Minnesotans connect with other service providers if their previous provider can no longer bill Medicaid. Marcus Schmit, executive director of NAMI Minnesota, expressed support for the process: “We see this as an opportunity to build a stronger, more reliable system for everyone.”
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.inforum.com/health/more-than-half-of-states-high-risk-medicaid-service-providers-disenrolled-dhs-data-shows