This article is a section taken from Minnesota Health Care Programs (MHCP), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
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
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
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
Minnesota Statutes, section 256.98
Social Security Act Section 1917b
CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.
This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.