Rep. Robbins Raises Concerns About Governor Walz’s Plan to Centralize Authority Over Medicaid at DHS

ST. PAUL – Despite billions in tax dollars being stolen from state taxpayers due to fraud that has gone unchecked by the Department of Human Services (DHS) for years, Governor Walz has unveiled plans to centralize control over Medicaid spending inside the DHS.

State Representative Kristin Robbins (R-Maple Grove) said while she agrees with the Governor’s suggestion to modernize technology used by state agencies and counties to provide social services programs, she is opposed to centralizing responsibility for 100% of Medicaid services at the agency that has allowed fraud in this state to run rampant for years.

Currently, eight non-profit Managed Care Organizations (MCOs) provide coverage for 80% of those on Medical Assistance (Medicaid) and Medicare in the state.  Each MCO has a Special Investigative Unit (SIU) which has forensic accountants and professional fraud investigators, who use the data analytic tools the state is hoping to acquire, to flag fraud.

“We absolutely need to prioritize upgrading technology this session,” stated Robbins. “That is a critical component of fighting fraud, and the state is woefully behind on this. Getting that piece done this session would make a material difference in stopping fraud.”

Robbins went on to state that, “taking Managed Care Organizations (MCO’s) out of providing Medicaid coverage is the exact wrong direction. MCO’s have flagged fraud and notified DHS and the Attorney General’s Medicaid Fraud Control Unit for years. They report either getting no response from DHS or the Attorney General, or being told they had to continue using providers about which they had raised concerns.”

“MCO’s are already doing what the state aspires to do in the fee-for-service programs they manage. The recent Optum report, which flagged 90% of the autism centers managed in the fee-for-service program, illustrated that DHS has not had a good track record in finding fraud and stopping payments. Why would we possibly want to centralize 80% more of our Medicaid program at DHS?

DHS should undertake the critical reforms outlined by Judge O’Malley in his ‘Roadmap to Program Integrity’ report and prove they can manage their current portfolio of 20% of the Medicaid population in the fee-for-service program, before any consideration is given to ending the role of the MCOs. DHS already has dozens of steps they can and must take to stop fraud. The three most important are establishing a culture of compliance and accountability, standardizing internal controls and supporting, not retaliating against, whistleblowers.

Without those internal changes at DHS being undertaken first, we will only be adding fuel to the raging fire of fraud by giving DHS 100% responsibility for all Medicaid programs and payments.

DHS must earn the Legislature’s and the public’s trust by getting the basics right, as outlined in Judge O’Malley’s report. In addition, DHS needs to actually respond to whistleblowers, including MCO’s, who flag fraud and try to stop payments.

I look forward to continuing to work with DHS to stop fraud and ensure our citizens get the service they deserve. We should get the state and county’s technology systems up to date this session, which will be a tremendous help in the battle against fraud. We should not take MCO’s out of the picture – they are currently the front line of defense, finding and stopping fraud on the front end.”