Skip to Content

Federal and State Program Integrity in Minnesota

        Minnesota has created a state agency within its Medicaid program that deals with fraud and abuse issues.  The state agency must investigate suspected cases of fraud, assess utilization issues within the program, and protect the unauthorized disclosure of information.1  The law requires the Commissioner of Human Services to seek monetary recovery from a vendor if payment for a recipient of medical assistance was based on fraud, theft, abuse, or error, or from a recipient of medical assistance, if payment for a health care service was based on fraud, theft, abuse, or error.2  The state of Minnesota follows the federal law in its law against the submission of false Medicaid claims by Medicaid vendors, and entitles the state to sue the individual and request treble damages.3

        The state also has laws governing action to be taken against an individual who is wrongfully obtaining medical assistance benefits under Medicaid.  The local agency must refer the individual to a local fraud investigation unit, issue a notice reducing or terminating the individual’s medical assistance eligibility, and if the investigation shows the local agency that fraud has occurred, the agency must refer the individual to the county attorney.4

 

Footnotes

  • 1. M.S.A. §256B.04
  • 2. MN ADC 9505.2215
  • 3. M.S.A. §256B.121
  • 4. MN ADC 9505.0131

 

Federal and State Program Integrity in Minnesota

Subtopic Statute/Regulation Description
Federal and State Program Integrity M.S.A. §256B.04 Duties of State Agency The state agency must supervise the administration of medical assistance programs by the counties.  The Commissioner must...
M.S.A. §256B.064 Sanctions; Monetary Recovery The Commissioner of Human Services may terminate payment to any Medicaid or Medicare provider who has been deemed...
M.S.A. §256B.121 Treble Damages A vendor of medical care who willfully submits a false report or claim for reimbursement that the vendor knows is false and is paid...
MN ADC 9505.0131 Wrongfully Obtained Assistance A local agency that receives information that a person may be wrongfully obtaining medical assistance benefits under...
MN ADC 9505.2200 Identifying Fraud, Theft, Abuse, or Error The Department of Human Services must investigate vendors of medical services or beneficiaries of medical...
MN ADC 9505.2215 Monetary Recovery The Commissioner of Human Services must seek monetary recovery from a vendor if payment for a recipient of medical assistance was...