According to a Report Poor Policy Language May Have Cost $1.7B Across 14 Medicaid Services in Minnesota

(Photo by Alyssa Chen/Minnesota Reformer)

(Minnesota Reformer) – Poorly written or vague policies may have cost state-run Medicaid services $1.7 billion in payments over nearly four years, a new state-commissioned report finds.

The report from Optum, a third party hired by the Minnesota Department of Human Services, also identified $52.3 million in Medicaid claims that did unambiguously violate clearly stated policy over that time, from January 2022 through October 2025. The report said that neither amount necessarily implies fraud, waste or abuse.

Optum reviewed a total of $9.4 billion in claims for 14 Medicaid services deemed high risk of fraud, waste and abuse by DHS, funded through a combination of state and federal dollars.

DHS Deputy Commissioner John Connolly noted in a press briefing that claims from early autism intervention centers were flagged by Optum’s analysis at a particularly high rate — over 90% of claims didn’t clearly match policies or procedures. And, of the $1.7 billion that could have been saved from better-written policies, $1 billion was spent on early autism intervention centers.