*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2011 |
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29.10 - Fraud |
Archived: June 1, 2016 (Previous Versions) |
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 MinnesotaCare adults without children.
MinnesotaCare Adults Without Children.
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.
Refer anyone you suspect of fraud for investigation.
l County agencies should refer cases to the county’s fraud investigators.
l MinnesotaCare Operations should refer cases to the HCEA MinnesotaCare Fraud Investigation Team.
Clients are not eligible for TMA or TYMA 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
Clients are not eligible during a period of Fraud Disqualification.
More general fraud information can be found on the DHS Web site, including how the public can report suspected fraud.