Minnesota Gov. Tim Walz has paused payments for 14 high-risk Medicaid services for up to 90 days while a third-party audit is conducted.
The state’s Department of Human Services has contracted with Optum, which will analyze Medicaid fee-for-service claims data and flag potential issues for the department’s review, according to an Oct. 29 news release from Mr. Walz’s office.
Optum’s analytics will identify irregularities, such as missing documentation, unusually high billing patterns or inconsistencies suggesting that a claim may not meet program requirements, according to the release.
The 14 services were designated as high-risk based on vulnerabilities, evidence of fraudulent activity and data analytics showing suspicious billing patterns or outliers.
Programs affected include early intensive developmental and behavioral intervention 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.
Claims flagged by Optum will be reviewed by the state to verify whether services were provided as billed, according to the release. Any suspected improper claims will be referred to the agency’s Office of Inspector General for further investigation.
