Minnesota Health Care Programs

1.3.2.3 Fraud

This policy covers the definition of fraud and referrals for investigation. The Minnesota Office of the Attorney General or the appropriate county attorney may prosecute or recover wrongfully obtained Minnesota Health Care Programs eligibility through a criminal action, a civil action, or both.

Fraud exists when:

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

By signing the application, an applicant or enrollee acknowledges that:

Their information will be shared for fraud investigations and audits as stated in the Notice of Privacy Practices
Their information may be shared with fraud investigators
Their consent does not end after one year for records given to fraud investigators

Suspected Fraud

Anyone can report suspected fraud on the DHS How to report fraud web page
The county, tribal or state servicing agency should refer suspected fraud to the appropriate fraud investigators
Health Care Eligibility Operations (MinnesotaCare) should refer suspected fraud to the MinnesotaCare Fraud Investigation Team

MinnesotaCare Disqualification

People who are age 65 or older are eligible for MinnesotaCare using state funds. They can be disqualified for MinnesotaCare if they are found to have committed an Intentional Program Violation (IPV) through any of the following:

A state or federal court conviction
A disqualification consent agreement
A pre-trial diversion
An Administrative Disqualification Hearing (ADH), or a waiver of an ADH

People disqualified from MinnesotaCare cannot receive coverage for the following time periods:

12 months for the first offense
24 months for the second offense
Permanently for the third offense

Legal Citations

Minnesota Statutes, section 256.98

Social Security Act Section 1917b