Minnesota Medicaid fraud investigators examining more autism service providers

Minnesota regulators are investigating a growing number of autism service providers for Medicaid fraud, and looking into additional oversight measures in the fast-growing field.

The Department of Human Services has active investigations into 29 individuals or agencies providing early intervention services, nearly twice the number of investigations it was conducting into such providers a couple months ago.

The Minnesota Reformer reported the FBI was looking into fraud in the program this summer. DHS told The Minnesota Star Tribune in July that it had 15 active investigations into autism service providers and 10 closed investigations.

The department sent a letter this week to Minnesota House Minority Leader Lisa Demuth, R-Cold Spring, noting the increased number of investigations and providing some information on the 10 closed cases. Demuth had requested additional details on the fraud investigations in July.

“I was surprised at the high number. I think 29 active investigations is huge,” Demuth said, adding that she is glad state investigators are digging into potential fraud. “The fact that the number of investigations have increased quickly is a good sign, but yet how many more are out there?”

The Medicaid-funded Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit helps people younger than 21 who have autism spectrum disorder or related conditions. The benefit can cover a range of services, from evaluation and treatment planning to intervention services, family training and counseling.

The number of young people receiving those services and providers doing the early intervention work has grown rapidly since Minnesotans started using the benefit in earnest in 2018. Early supports for kids with autism are critical and there is a high demand for the services, families of children with autism and experts in the field have said.

DHS staff did not comment Wednesday on what is driving the increased number of investigations into such providers or whether there are trends in the cases the agency is examining.

“DHS takes seriously our role in promoting the health, safety and well-being of children and vulnerable adults, and our obligation as a steward of a significant amount of public dollars. The Office of Inspector General continues to review tips, referrals and data to identify the need for investigations,” department officials said in a statement.

In the letter to Demuth, DHS Inspector General Kulani Moti said there are nearly 300 agencies doing the early autism intervention work that are enrolled in Minnesota Health Care Programs.

The agency does screening site visits when a provider is enrolling in the health care programs, Moti noted, and providers have to fill out an assurance statement attesting that they have certain experience and training. Individuals in contact with kids and families also have to pass a background check. The state does a revalidation screening process for the autism service providers every five years.

Moti outlined two potential next steps that could bring additional oversight: Licensing service providers and clarifying whether DHS should be required to review the employment status of providers. The agency has been consulting with people in the autism community on whether the state should license early intervention providers and is going to give lawmakers recommendations on that issue in the upcoming legislative session, the letter said.

“We look forward to working with you in the upcoming legislative session to strengthen the oversight of EIDBI,” Moti wrote.

The letter also listed the outcomes in the 10 closed investigations into autism intervention providers from the past five years. In the most recent cases, both closed this January, the state recovered more than $86,000 from Northstar Therapy Services in Edina, and recovered $192,000 and leveled a $5,000 fine on St. Paul-based Senzilla Health Services Inc.

The list also includes an investigation into Sharmarke Issa that was closed in June 2023 and resulted in the provider being “terminated” from receiving Medicaid payments. Issa, the former board chair of the Minneapolis Public Housing Authority, pleaded guilty to wire fraud Wednesday in federal court in connection with the Feeding Our Future scheme, which centered around federal meal programs for low-income children.

The 29 ongoing investigations into autism service providers are just a fraction of the 565 open investigations within DHS’s Medicaid Provider Audits and Investigations unit. That unit looks into issues with billing and services by providers who are paid through Medical Assistance, Minnesota’s Medicaid program.