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Minnesota DHS Mobilizes 168 Staff for Unannounced Site Checks in Medicaid Fraud Crackdown

The effort will revalidate 5,800 providers in high‑risk Medicaid services through unannounced visits.

Overview

  • Officials branded the initiative “Minnesota Revalidation,” calling it an unprecedented expansion of provider screening that includes document reviews, background checks and in‑person inspections.
  • Staff training begins in February with site visits to follow, focusing on 13 services DHS labels high risk for fraud, waste and abuse.
  • A separate prepayment review launched in December delayed reimbursements, and some providers report lingering shortfalls, including one operator citing more than $600,000 still outstanding.
  • DHS and Optum are reviewing about 100,000 claims every two weeks, with more than 70 denials so far and no claims flagged as fraudulent, according to Temporary Commissioner Shireen Gandhi.
  • The Trump administration says it intends to withhold $2 billion tied to these programs, which Minnesota is appealing after submitting a revised corrective action plan, as bipartisan lawmakers prepare fresh oversight when the Legislature reconvenes.