Lack of Oversight Responsible for Minnesota Billion Dollar Medicaid Fraud
Republished with permission from AbleChild
The Minnesota billion-dollar Medicaid fraud is about human failure. While the media currently is placing blame on failed vice-presidential candidate, Governor Tim Walz, this story is about an entire state apparatus that failed. That’s right. This is a story of humans paid to ensure that state and federal dollars were correctly spent…to be responsible stewards of the public treasury but whether by accident or intent failed miserably.
The buck obviously ultimately falls with Walz as Governor of the State and, in light of statements made by state personnel, Walz may very well be singularly responsible for the billion-dollar Medicaid fraud and may face re-election repercussions and even civil or criminal lawsuits.
Afterall, State employees accuse Walz of “systematically retaliating against whistleblowers using monitoring, threats, repression and did his best to discredit fraud reports.” The state employees further report that “instead of partnership we got the full weight of retaliation by Tim Walz.”
These statements were posted on the social media site X, but no backup documentation was provided to support the damning statements. But AbleChild knows well that the Medicaid programs that have been frauded were administered by state employees. Somebody in the state – some human – was aware of the fraud in the numerous Medicaid programs very early on.
There was no need to wait for whistleblowers within the frauded programs. State employees knew about the fraud so the question that needs to be asked is who had oversight? Who was responsible for ensuring that the Medicaid money (50% state funds and 50% federal funds) paid out was going to legitimate programs? Who in the Department of Health Services was boots on the ground, ensuring that the Medicaid “providers” actually existed and were legitimately providing services?
In January of this year, AbleChild wrote about fraud in the Early Intensive Developmental and Behavioral Intervention (EIDBI) treatment program in Minnesota. The program was created in 2017 to provide intensive treatment for autistic children under the age of 18 and was frauded to the tune of hundreds of millions of dollars.
It’s of interest that when the program began, 41 children were treated in the program and two years later a whopping 328 were in the program, increasing Medicaid funding to the EIDBI providers 3000%. The FBI raided two of the EIDBI providers and found “substantial evidence that many of these companies have been submitting fraudulent claims for EIDBI services that were not actually provided or were not covered by the EIDBI program.”
So, after lengthy searches, it appears that state statute of the EIDBI program places the Commissioner of the Department of Health Services in Minnesota in charge of oversight of the EIDBI program. But everyone knows that Commissioners never do the actual work. State employees are hired to carry out the actual oversight. Unfortunately, there are no names or offices that are made public that reveal who the Commissioner put in place as boots on the ground to ensure the EIDBI program ran correctly.
A completely useless EIDBI Advisory Group was set up to provide community/professional input on the EIDBI program, but after careful review, AbleChild would suggest there are major conflicts of interest within the Advisory Group that may have led to some of the EIDBI fraud. AbleChild will follow up with an in-depth look at those conflicts of interest in the Advisory Group in a future article.
It is of interest, however, that of the 21 Advisory Group meetings held between 2017 and 2021 (no other meetings are listed in the archives after 2021) not one mention is made about any fraud within the EIDBI program. Zero. In fact, within a year of the program beginning, the Advisory Group recommended expansion of the EIDBI program with increased numbers of “providers.”
Many would argue that this expansion of the number of “providers” by the Commissioner of the Department of Health Services ultimately greatly increased the fraudulent Medicaid billing. It also should be noted that AbleChild was unable to find any mention by the Advisory Group of any oversight of the EIDBI program. The mentality among the Advisory Group appears to be focused on expanding services yet providing no guidance about who would provide oversight or even how oversight would happen among the EDIBI providers.
But the oversight issue should have been picked up by state employees who handle the payment of these providers. Afterall, would the extreme jump in the numbers of autistic children not catch someone’s attention at the state payment level? Was there not one state employee who questioned the increase of payments from $32 million in 2020 to $81million in 2021 and again rising to $133 million in 2022?
The Commissioner must answer for the obvious lack of oversight because had there been any oversight, AbleChild doubts the fraud would have occurred in the EIDBI program. These aren’t tough questions. Did the Commissioner of the Department of Health Services set up oversight of the EIDBI program and where can the oversight guidance be found?
Did the Commissioner ever have state employees validate EIDBI providers in person? Were there boots on the ground (even periodically) validating that the providers existed and were providing the services billed to the state? If not, why? Why would there have been no oversight into the EIDBI program required by the legislature or the Commissioner of the Department of Health Services?
The bottom line here is that real people run these Medicaid programs. The billing and payments are handled by flesh and blood people. How could the fraud have continued for years and hundreds of millions of dollars without state employees knowing about it?
While there now are a gazillion state and federal audits being conducted into the Minnesota Medicaid system, someone needs to ask the state employees what they saw. Was it a case of intimidation from the higher ups that caused the years-long fraud? If so, documented proof of the intimidation within the state agency needs to be made public. If not, then serious questions need to be asked about why there was no oversight of a billion dollars paid to seriously questionable Medicaid program providers.
Questions need to be asked of the legislature and of the numerous Commissioners who oversaw the EIDBI program. It seems completely unrealistic that legislators would enact programs without providing guidance on the oversight of the program. Humans are responsible. Whether by accident or intent, this fraud was carried out because humans allowed it to happen. The fraud did not happen in a vacuum. Blaming fraud on the guy at the top is too easy. There are lots of state employees between the provider and the Governor. It’s time to ask what did they know about this colossal fraud and let the chips fall where they may.
Be the Voice for the Voiceless
AbleChild is a 501(3) C nonprofit organization that has recently co-written landmark legislation in Tennessee, setting a national precedent for transparency and accountability in the intersection of mental health, pharmaceutical practices, and public safety.
What you can do. Sign the Petition calling for federal hearings!
Donate! Every dollar you give is a powerful statement, a resounding declaration that the struggles of these families will no longer be ignored. Your generosity today will echo through generations, ensuring that the rights and well-being of children are fiercely guarded. Don’t let another family navigate this journey alone. Donate now and join us in creating a world where every child’s mind is nurtured, respected, and given the opportunity to thrive. As a 501(c)3 organization, your donation to AbleChild is not only an investment in the well-being of vulnerable children but also a tax-deductible contribution to a cause that transcends individual lives.
The post ABLECHILD: Lack of Oversight Responsible for Minnesota Billion Dollar Medicaid Fraud appeared first on The Gateway Pundit.