Full Breakdown
Minnesota's Autism Program Faces Scrutiny Over Fraud Concerns
2/11/2026, 6:54:34 AM
Overview of Claims and Fraud Analysis
A recent analysis conducted by Optum revealed that 90% of claims submitted to Minnesota's Early Intensive Developmental and Behavioral Intervention (EIDBI) program from January 2022 to October 2025 were flagged for not aligning with state policies. This finding was disclosed by John Connolly, Deputy Commissioner of the Minnesota Department of Human Services (DHS), during a briefing on a new prepayment review system aimed at combating fraud in Medicaid-funded programs. The EIDBI program, which provides funding for autism services, has seen its costs rise dramatically from $83 million in 2021 to an estimated $342 million by 2024.
Development of Prepayment Review System
The prepayment review system, developed in partnership with Optum, utilizes advanced analytics and artificial intelligence to assess claims before payments are made. Claims flagged by the system are subject to further review, with the intention of preventing potential fraud. Connolly emphasized that while a flagged claim does not automatically indicate fraud, it highlights areas where further investigation is necessary. The DHS aims to refine the system to ensure that legitimate claims are not unduly flagged, with hopes of having it fully operational by the end of the year.
Financial Discrepancies Among Care Providers
In a related investigation, three care providers—Ausome Development Center Inc., Amni Corporation, and Taaj Daycare Center Inc.—were found to have received a total of over $12.3 million in state funds, significantly more than previously reported. Ausome Development Center, initially reported to have received $2.5 million, was later found to have received nearly $4.8 million. Observations at the facility raised questions about the actual services provided, as no children were seen during visits.
Similarly, Amni Corporation's reported funding increased from $1.1 million to over $3.8 million, despite claims of being at full capacity with 35 participants. However, visits revealed only a few individuals present, raising concerns about compliance with state regulations. Taaj Daycare Center's funding was also revised from approximately $794,000 to about $3.7 million, with reports of operational deficiencies noted in a 2025 correction order.
Criticism and Concerns
Critics have raised alarms regarding the apparent discrepancies in funding and the operational practices of these care providers. The DHS has recognized autism services and adult day care programs as high-risk areas for fraud, leading to a temporary licensing moratorium for adult day centers that began on February 1, 2025. This moratorium will last for 24 months, during which new license applications will not be accepted.
Official Statements and Future Actions
Connolly stated, “This is not a measure of fraud, waste and abuse, but it shows us where we need to do more work to understand why these claims are raising red flags.” He acknowledged the need for policy clarifications and better training for providers to ensure proper claim submissions. The DHS plans to continue refining the prepayment review system and will refer any suspicious past activities to law enforcement.
Verbatim Quotes
- “We may need to clarify policies so claims that deserve to be approved are not unnecessarily flagged,” — John Connolly, Deputy Commissioner, Minnesota Department of Human Services
- “This is not a measure of fraud, waste and abuse, but it shows us where we need to do more work to understand why these claims are raising red flags,” — John Connolly, Deputy Commissioner, Minnesota Department of Human Services
Conclusion
As Minnesota's DHS works to enhance its oversight of Medicaid-funded programs, the findings from the claims analysis and the scrutiny of care providers underscore the ongoing challenges in ensuring accountability and transparency within the state's autism services. The implementation of the prepayment review system is a critical step in addressing these issues, with the potential to significantly impact future claims processing and fraud prevention efforts.
