Heavily-redacted audit finds Minnesota Medicaid had widespread vulnerabilities

A vulnerability assessment by Optum State Government Solutions analyzed nearly four years of claims data, identifying widespread financial risks and specific weaknesses in 14 high-risk service areas - including housing stabilization and personal care assistance.

While more than a dozen high-risk areas were identified, the actual descriptions of the vulnerabilities found within each program are redacted, along with references to "recurring vulnerabilities" that appeared across nearly all services.

The high-risk service and program areas identified, in order of priority, are:

2. Peer Recovery Support Services (PRSS)

3. Early Intensive Developmental and Behavioral Intervention (EIDBI)

4. Integrated Community Supports (ICS) (Home and Community Based Service)

5. Non-Emergency Medical Transportation (NEMT)

7. Personal Care Assistance (PCA) / Community First Services and Supports (CFSS)

8. Adult Day Services (ADS)

9. Recuperative Care (RS)

10. Individualized Home Supports (IHS) (covers services without training, with training, and with family training)

11. Adult Companion Care (ACC)

12. Night Supervision (NS)

13. Assertive Community Treatment (ACT)

14. Intensive Residential Treatment Service (IRTS)

The report also withholds specific "tactical issues" and methods related to how claims are adjudicated and audited.

A notice at the beginning of the document states it contains "trade secret information," which seemingly covers Optum's proprietary analytic models and fraud-detection methods.

Despite the redactions, the report outlines a roadmap for the Minnesota Department of Human Services (DHS) to recover improper payments and modernize its fraud detection infrastructure. 

While state officials said they are reviewing the findings, some lawmakers, including State Rep. Patti Anderson, R-Dellwood, said the guidance is unclear.

"It's frustrating that the Walz administration redacted almost the entire report," Anderson told the Minnesota Star. "It makes you wonder what they're hiding… We're all frustrated. Unfortunately, it's not a surprise."

Optum did not immediately respond to Fox News Digital's request for comment on the redactions.