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Medicaid Program Integrity Update - July 2026 |
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“Fraud perpetrated against the State is unacceptable and my administration will not tolerate the abuse or misuse of public funds.”
Governor Tim Walz, Executive Order 25-10 (PDF)
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Temporary moratorium on enrolling high-risk service providers extended
The Centers for Medicare & Medicaid Services has approved DHS' request for a six-month extension of the temporary moratorium on enrolling new providers of high-risk services. This extends the moratorium through January 27, 2027.
DHS will continue to:
- No longer accept new provider enrollment applications for these services,
- Not process any new provider enrollment submissions, including those previously submitted and currently pending in the queue,
- Keep the moratorium in place for at least six months and extend it if necessary.
This extension does not impact Early Intensive Developmental and Behavioral Intervention (EIDBI) providers. There is currently a separate moratorium on enrolling new EIDBI providers that runs through October 31, 2026. This moratorium also does not impact providers of high-risk services who are currently enrolled.
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Early Intensive Developmental and Behavioral Intervention services public e sessions
DHS is inviting the public to provide in-person, virtual and online feedback about draft licensing standards for EIDBI services. Licensure was passed by the legislature in 2025 and is an important part of strengthening DHS’ oversight of Medicaid-funded EIDBI services and ensuring children and families receive safe, high-quality care.
DHS especially hopes to hear from those most impacted and will use the feedback gathered to finalize recommendations to the legislature in January 2027. If the standards are passed into law, they are expected to take effect no earlier than 2028, giving those impacted time to plan. Visit the new EIDBI licensing standards engagement web page for more information on in person and virtual sessions, or to leave your feedback directly through the site.
Governor Walz signs MAP Act and Health and Human Services Omnibus Bill
Governor Tim Walz signed the MAP Act, which provides Minnesota’s Medicaid Fraud Control Unit (MFCU) at the Minnesota Attorney General’s office with additional resources and stronger legal tools to hold Medicaid fraudsters accountable. MFCU takes on the majority of DHS’ cases for prosecution, and expanding their staffing will help hold fraudsters accountable and reduce the case backlog. The act adds 11 investigators, three attorneys, and four support staff to MFCU, expanding their total staff from 32 to 50. This act also creates enhanced sentencing for high-dollar fraud cases, expands the statute of limitations, and increases the state’s ability to recover tax dollars lost to fraud.
Governor Tim Walz also signed into law several vital program integrity measures, including:
- Modernizing Medicaid program safeguards so that providers go through pre-enrollment risk assessments and post payment reviews,
- Expanding DHS data analytics to adapt to emerging fraud risks,
- Establishing licensing for Adult Rehabilitative Mental Health Services (ARMHS), which gives DHS more tools to oversee the program,
- Modifying and adding billing limits and other oversight measures for disability, older adult, and behavioral health services,
- Adding 15-minute billing units and acuity limits for Integrated Community Supports, which ensures that services accurately reflect individual needs and reduces inappropriate billing,
- Expanding electronic visit verification requirements (EVV) to include most high-risk services and additional Home and Community Based Services. EVV uses an electronic system and GPS software to verify multiple data points, including location of service delivery, date of service, who receives services, who provides services, and when the service begins and ends. This will significantly expand DHS oversight for these services and help build stronger program integrity.
Attorney General Ellison announces Medicaid fraud charges against seven providers
On June 23, Attorney General Keith Ellison announced his Medicaid Fraud Control Unit (MFCU) participated in National Health Care Fraud Takedown Day with the federal Department of Justice and over 40 other state MFCUs. Minnesota’s MFCU charged seven providers with over $700,000 in Medicaid fraud. Minnesota’s Attorney General Office provided additional information in their news release.
Minnesota’s MFCU builds cases from DHS’ investigations, and since 2019 our MFCU has secured more than 340 convictions for Medicaid fraud and won over $90 million in judgments and recoveries. An audit from the U.S. Department of Health and Human Services Office of Inspector General found that Minnesota’s MFCU has secured more convictions than any state in the country with a similarly sized Medicaid budget.
Attorney General Ellison said, “I have no patience for anyone who would steal our tax dollars, especially when those tax dollars are meant to provide health care for low-income Minnesotans who couldn’t afford it otherwise. My Medicaid Fraud Control Unit is one of the best in the nation, and today’s charges demonstrate that we are working hard day in and day out to hold Medicaid fraudsters accountable and recover the tax dollars they stole from hardworking Minnesotans.”
Inspector general James Clark made the following statement in response to the charges: “We applaud today’s charges from the Minnesota Attorney General’s Office. The Minnesota Department of Human Services has been working with our partners in law enforcement, sharing credible evidence of fraud when we find it and by supporting the prosecutors who build cases to charge criminals."
DHS referred two of the cases to the Attorney General’s Office in 2024 and cut off payments to many of these providers two years ago or more.
Inspector General Clark's statement on May federal fraud charges
On May 21, U.S. Department of Justice officials announced filings of criminal charges against 15 Minnesotans who allegedly defrauded a combined $90 million from state and federal funds. Human Services Inspector General James Clark issued the following statement about the Medicaid fraud charges:
“We have been working with career federal and state partners for months to help them build criminal cases against most of these individuals – providing billing and ownership information, investigative files and treatment records for many of the businesses. Medicaid is meant for helping people who truly need it, not lining the pockets of criminals.
“My office continues to use our administrative power to shut off money to these and other Medicaid providers as soon as we uncover credible allegations of fraud, which we’ve done more than 600 times over the past 18 months. In fact, we stopped payments to some of the businesses connected to today’s charges more than a year ago.
“We are working more aggressively than ever to prevent and stop Medicaid fraud – tightening up oversight on the front end and taking action to stop criminals. As our efforts continue, we fully expect to see more charges.”
Since Jan. 1, 2025, the agency has stopped payment to 745 providers based on credible allegations of fraud and made 815 referrals to law enforcement.
State agencies and law enforcement have complimentary roles to protect the public. The department has administrative authority to stop payments as soon as we establish credible evidence of fraud, while state and federal law enforcement agencies take time to build cases to prosecute criminals.
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DHS fact check
Prosecution actions
How we are helping providers
We work to maintain an ethical balance between a zero tolerance for fraud and giving providers, counties, and Tribes the support and resources they need to keep clients safe. We aim to provide aggressive yet safe timelines when actions are taken, and we recognize the burden carried by our partners who often work with limited resources, capacity, and staffing. We are continuously adding ways to support providers, for example:
Minnesota DHS action tracker
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Identified 14 Medicaid services at high risk for fraud
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Established a freeze on adding new service providers in those programs
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Initiated third-party review of fee-for-service claims before they are paid
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Discontinued the Housing Stabilization Services program
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Audited autism service providers, including on-site visits
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Disenrolled inactive providers
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Expanded use of analytics to prioritize review of payments before and after they are made
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Created Medicaid Program Integrity website and newsletter to improve transparency
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Implementing licensures for autism centers
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Developing enhanced training for providers and state employees who work on Medicaid provider training and education
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Developing additional training for state employees who work on Medicaid (ongoing)
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Planning systems for increased oversight of large health care providers providing managed care services
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Working with providers who are appealing their disenrollment through the revalidation process.
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Accessible formats
For accessible formats of this publication, write to dhs.communications@state.mn.us, or call 651-431-2000 or use your preferred relay service.
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