The conclusion of a special series by The Star Tribune reveals that Minnesota remains vulnerable to home health fraud, despite oversight changes from the Department of Human Services. The state fails to identify and recover fraudulent billing practices and to consistently prosecute those responsible, according to a recent article.
Of the 425 home health agencies notified of wrongful billing practices since 2008, just 25 percent were convicted, according to The Tribune. Despite significant growth in the state's home health sector, anti-fraud enforcement has been cut in half since 2011. An interactive graph showed that Minnesota ranks among the bottom of states when it comes to civil and criminal recoveries from Medicaid fraud, despite ranking as the 12th-highest state in total Medicaid expenditures. Over the past two years, the Department of Human Services has referred 28 cases of suspected home care fraud, down from 44 in 2012 and 38 in 2011.
"I'm sick of competing with crooks," Jill Knutson-Kaske, an administrator at Heartland PCA, a personal care assistance provider, told the newspaper. "You do the right thing … you fire the person and you turn them in--and then see them working for someone else. It gives us all a bad name."
Fraud prevention problems in Minnesota date as far back as 2009, when a legislative auditor said the state's home care program was "unacceptably vulnerable to fraud and abuse." Subsequent changes have done little to improve this assessment, although the newspaper notes that the Department of Human Services has begun conducting surprise spot-checks for new home health providers.
In an accompanying editorial, the Tribune called for "tighter controls and oversight," pointing to high-profile cases in which a home health company was ordered to pay just $50,000 in restitution for $2.7 million in false claims. In December, the former mayor of Stillwater, Minnesota was entangled in a home health fraud investigation that alleges millions in fraudulant Medicaid payments, FierceHealthPayer: AntiFraud previously reported.
Home health has been a focus of fraud around the country over the past year, but the Tribune editors said the state hasn't done enough to control fraud and abuse, such as utilizing federal authority and funding to analyze claims.