Other flagged Medicaid programs
The Minnesota Department of Human Services (DHS) identified 14 Medicaid service types as high risk for fraud, waste, and abuse, including nonemergency medical transportation, adult day services, peer recovery, and integrated community supports. The state hired Optum to review $9.4 billion in claims across these services. The review flagged about $1 billion in payments needing closer review and $52.3 million in clear policy violations. The report says neither figure necessarily means fraud.
How the scheme worked, per prosecutors and auditors
The May 2026 federal takedown charged 15 defendants across seven programs, four Medicaid benefits (autism therapy, Individualized Home Supports, Integrated Community Supports, and Housing Stabilization) and three others (two child-care subsidy programs and the federal child-nutrition program). Prosecutors put the intended loss, meaning the amount they say the schemes aimed to take, at more than $90 million. Charges in these programs are recent, and as of October 2026 most cases are pending.
Where things stand
Programs operating under three restrictions. Claims are checked before they are paid (prepayment review). New providers are frozen out of the 12 remaining high-risk services under a moratorium approved by the federal Centers for Medicare & Medicaid Services (CMS), effective January 27, 2026 and extended through January 27, 2027. About 5,600 providers also had to re-verify their enrollment early. The Minnesota Department of Human Services (DHS) reported in June 2026 that this had cleared 2,061 and sent 3,411 disenrollment notices, many later reversed on appeal. DHS said in July 2026 it had stopped payment to 745 providers on credible fraud allegations since January 1, 2025. Prosecutions are in early stages.
The key numbers
Each figure says what it measures. A spending total is not a fraud amount.
People charged in this program
All selected defendants →A starter set of principal defendants, not a complete list. Each status comes from a documented court step.
Healey Homes (Individualized Home Supports provider)
Healey Homes (Individualized Home Supports provider)
Ultimate Home Health LLC (Integrated Community Services provider)
Milestones
- January 27, 2026ReformOther flagged programs
Enrollment freeze across the 12 remaining high-risk services
A six-month freeze on enrolling new providers, approved by the federal Centers for Medicare & Medicaid Services (CMS), takes effect for the 12 high-risk services not already frozen (the autism-therapy program, EIDBI, has its own). In July 2026 CMS approves an extension through January 27, 2027.
- February 6, 2026Audit / reviewOther flagged programs
Optum review flags $1 billion for closer review
A state-commissioned review of $9.4 billion in claims across the 14 high-risk services identifies about $1 billion in payments needing review and $52.3 million in clear policy violations. The report says the figures do not necessarily imply fraud.
- September 24, 2026Audit / reviewOther flagged programs
Legislative Auditor summarizes the redacted Optum vulnerability assessment
At a legislator’s request, the Legislative Auditor publishes a summary of Optum’s January 31, 2026 vulnerability assessment of the 14 high-risk programs, which the Department of Human Services had released heavily redacted. The auditor recommends recurring fraud risk assessments and a legislative review of duplicative services, and notes it did not independently verify Optum’s work.
People charged but not convicted are presumed innocent, and amounts labeled alleged come from charging documents, not proven losses. Method and corrections
Written by Dan Swenson, an attorney who serves on the Nowthen City Council, in his personal capacity. It is not an official publication of the City of Nowthen or any other government.