By Lori Swanson, MN Attorney General
Medicaid and other public health care programs provide important “safety net” health coverage to eligible low-income Minnesotans, including pregnant women, children, senior citizens, and individuals with disabilities.
The U.S. Department of Health and Human Services Office has estimated that nationwide fraud costs public health programs billions of dollars each year. Health care fraud then bilks taxpayers; every dollar diverted to fraud is a dollar not spent on patient care.
For example, in southern Minnesota, a home care company was billed for services that were not provided, and also provided services without a nurse on staff to supervise patients’ care. The owner was later convicted of six felonies and ordered to pay back the money.
In a separate case, while her exhusband was overseas a woman forged his signature on timesheets stating that he provided her with home care services. She pled guilty to felony charges and was ordered to pay back almost $45,000 in stolen funds.
A Twin Cities area woman claimed to provide medical interpreter services to patients during times when she was clocked in and working at another job. She was convicted of felony theft.
Public health care fraud affects everyone. Tips from the public often help the authorities catch and stop fraudulent schemes. Health care fraud schemes may include, among other things:
• Billing for medical services that were not actually provided.
• Billing for more expensive services than provided.
• Giving or accepting cash or gifts to convince a recipient to seek or continue medical services.
The Minnesota Department of Human Services Surveillance and Integrity Review Section (SIRS) has the authority to investigate suspected public health care fraud, recover overpayments, and refer cases to authorities for criminal investigation and prosecution. SIRS has established a hotline for people to report public health care fraud. SIRS’ Fraud Hotline can be reached as follows:
Twin Cities Metro: (651) 431- 3968Toll-free: (800) 627-9977
You may also file a fraud report, at https://fraudhotline.dhs.mn.gov/. SIRS states that people can report fraud anonymously.
Good Samaritans can help stop fraudulent schemes and keep taxpayers from getting bilked. If you become aware of fraud in the Medicaid program, you should report it to SIRS at (651) 431-3968 or tollfree at (800) 627-9977.