Fraud (Archive)

This section covers the definition of fraud, referrals for investigation, and how fraud affects eligibility.

Refer to Administrative Disqualification Hearings for specific provisions related to administrative disqualification for GAMC and MinnesotaCare adults without children.

What is Fraud?

Suspected Fraud.

Ineligibility Due to Fraud.

TMA/TYMA.

MinnesotaCare Adults Without Children and GAMC.

Related Topics.

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What is Fraud?

Fraud exists when any of the following occur:

l  People willfully or intentionally provide a false statement or withhold, conceal or misrepresent information to receive or attempt to receive coverage for which they are not eligible.

l  People plan with or knowingly help another person to fraudulently seek or obtain assistance.

To establish fraud in an Administrative Disqualification Hearing, the agency must establish an Intentional Program Violation (IPV) consisting of a willful or intentional false statement, a concealment of a fact, or a misrepresentation.

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Suspected Fraud

Refer anyone you suspect of fraud for investigation.

l  County agencies should refer cases to the county‚Äôs fraud investigators.

l  MinnesotaCare Operations should refer cases to the HCEA MinnesotaCare Fraud Investigation Team.

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Ineligibility Due to Fraud

TMA and TYMA

Clients are not eligible for TMA Transitional Medical Assistance. Up to four months of additional medical coverage provided to some people terminated from regular MA because of increased child or spousal support. or TYMA Transitional Year Medical Assistance. Up to 12 months of additional medical coverage provided to some people terminated from regular MA due to increased earnings, loss of earned income disregards, or a combination of loss of child/spousal support and increased earnings/loss of earned income disregards. if convicted of MA fraud in:

l  Any of the six months before termination of regular MA.

l  Any month of TMA or TYMA eligibility.

Remove caretakers who are convicted of fraud. The children may remain on TMA or TYMA.

MinnesotaCare Adults Without Children and GAMC

Clients are not eligible during a period of Fraud Disqualification.

For GAMC only, people who are convicted of making fraudulent statements about residence to receive duplicate assistance from two or more states are ineligible for 10 years.

Related Topics

More general fraud information can be found on the DHS Web site, including how the public can report suspected fraud.

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