Inconsistent Information

The county, tribal or state servicing agency must verify inconsistent information when the information provided by the applicant or enrollee is inconsistent with:

  • Other information the agency has

  • The applicant or enrollee’s own statements

  • Information collected for purposes of a case review, audit, fraud investigation or overpayment analysis

  • Information obtained from electronic sources

The county, tribal or state servicing agency must verify information that is inconsistent with documentation or information on file if all of the following conditions exist:

  • The information is necessary to determine at least one of the following:

    • Eligibility

    • Premium amount

    • Spenddown
  • The information is inconsistent with at least one of the following:

    • Other information the agency has

    • A client’s own statements
  • The client cannot satisfactorily explain an inconsistency

Enrollees must provide information and proofs within 10 days when inconsistent information is received or discovered between renewals. An enrollee’s health coverage may end if they fail to respond to an inquiry regarding inconsistent information.

See the MHCP Fraud policy if there is reason to suspect an applicant or enrollee is withholding, concealing or misrepresenting information.

Legal Citations

Code of Federal Regulations, title 42, section 435.952

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.