This article delves into the concerning issue of Medicaid fraud within the realm of early intervention services. It exposes how some medical providers, both those not legitimately affiliated with certain companies and those located outside the United States, were billing Medicaid for EIDBI services. Like Smart Therapy, Star Autism Center also came under scrutiny for submitting large Medicaid claims for services that seemed improbable. Moreover, Star Autism Center billed Medicaid during periods when clients were attending school or otherwise unavailable for therapy.

Regulatory Challenges and Growth of the Autism Program

In Minnesota, nearly 300 agencies are involved in early intervention work. However, there is very little regulatory oversight as autism centers are not licensed. This lack of oversight makes it difficult for the state Department of Human Services to track caseload size and staffing ratios. Since the launch of the Minnesota autism program in mid-2015, it has witnessed rapid growth. Especially since 2018, when Minnesotans started using the benefit in earnest, the number of providers has increased from 41 to 328 last year. Simultaneously, the amount paid to providers has skyrocketed from about $6 million to nearly $192 million. This significant growth raises questions about the integrity of the system. 1: The lack of proper regulation allows for potential fraud to go undetected. With no clear guidelines and limited monitoring, it becomes easier for providers to engage in fraudulent activities. The increase in the number of providers and the substantial rise in payments highlight the need for stricter oversight and better monitoring mechanisms. 2: The growth of the autism program presents both opportunities and challenges. On one hand, it shows the increasing recognition and demand for early intervention services. On the other hand, it also exposes the vulnerabilities in the system that can be exploited by fraudsters. It is crucial to find a balance between providing necessary services and ensuring the integrity of the Medicaid program.

Investigations and Withheld Payments

As of September, the Department of Human Services was actively investigating 29 individuals or agencies providing early intervention services. Since 2018, the agency has withheld payments from seven providers due to credible fraud allegations. Five cases were also forwarded to the attorney general's Medicaid Fraud Control Unit. Additionally, the Office of Inspector General has withheld payments from seven providers. Over the past five years, another 10 investigations were closed. For example, an investigation into Sharmarke Issa was closed in June 2023, resulting in the provider being "terminated" from receiving Medicaid payments. Issa, the former board chair of the Minneapolis Public Housing Authority, pleaded guilty to a federal wire fraud charge in connection with the Feeding Our Future case. 1: These investigations and withheld payments indicate the seriousness of the issue. The fact that multiple providers have been targeted shows that fraud is not an isolated incident but a widespread problem within the system. It is essential to take decisive action to prevent further fraud and protect the interests of Medicaid beneficiaries. 2: The closure of investigations and the termination of providers serve as a warning to others who may be considering engaging in fraudulent activities. It shows that the authorities are committed to rooting out fraud and holding accountable those who violate the law. However, more needs to be done to strengthen the investigative and enforcement mechanisms to ensure the long-term integrity of the Medicaid program.This is a developing story, and readers are advised to stay tuned to startribune.com for updates.