How Far Up Does the Mental Health Fraud Go in Minnesota’s Medicaid Fraud Case?

January 13, 2025

Medicaid fraud is apparently rampant in Minnesota’s Somali-speaking communities and, according to federal warrants, hundreds of millions of taxpayer funds may have been paid for services never provided. How, one might ask, is a financial fraud of this magnitude possible without state officials being aware? It’s simple. Zero oversight.

In a nutshell, the Minnesota legislature created the Early Intensive Developmental and Behavioral Intervention (EIDBI) treatment program in 2017. The purpose of EIDBI was to provide intensive treatment to children under the age of 18 on the autism spectrum. Since the creation of EIDBI there has been a remarkable boom in autistic cases in Minnesota, especially among Somali children.

According to one report the providers of this “intensive” autism treatment have increased 700% in just the past five years from 41 in 2018 to 328 in 2023. Along with that increase is the amount of Medicaid funds paid out. During the same timeframe there was a 3000% increase in Medicaid funds paid to these autism providers rising from $6 million to nearly $200 million.

Earlier this year the Federal Bureau of Investigation (FBI) raided two autism care providers as part of its investigation into Medicaid fraud in Minnesota. Smart Therapy Center in Minneapolis and Star Autism Center in St. Cloud which cater to the Somali community received nearly $10 million dollars in Medicaid payments.

According to the FBI search warrants of Smart Therapy and Star Autism Center, “the investigation has found substantial evidence that many of these companies have been submitting fraudulent claims for EIDBI services that were not actually provided or that were not covered by the EIDBI program.”

The State Medicaid payments for autism treatment grew at an astounding rate from $32 million in 2020 to $81 million in 2021 going as high as $133 million in 2022 and more than $200 million in 2023. And it is of interest that these same treatment centers also are connected to another fraud regarding the Feeding Our Future case in Minnesota where claims were made by providers for more meals than were served or never served any to the tune of $250 million. Smart Therapy Center reportedly participated in the Feeding Our Future program to the tune of $465,000 that apparently was “grossly inflated” meals claims.

The reported Medicaid fraud being investigated by the FBI began when a supervisor of Smart Therapy Center reported the fraud advising FBI agents that the employees were “18- or 19-year-old relatives of the owners who had no formal education beyond high school and no training or certification related to the treatment of autism.”

According to the supervisor, the Smart Therapy Center’s owners hired these unqualified employees because “they were relatives of the owners, cheap labor and were unlikely to question what was going on at the company.”

Even more interesting beyond employees being unqualified to be intensive treatment care givers, an employee reported that many of the clients “did not appear to be autistic” and further explained that the owners recruited new clients by “talking to parents they knew and even knocking on doors in the community and trying to talk parents into getting their children into autism treatment.”  And, quite believable, the employee also admitted that they believed the owners “paid parents of clients to bring their children to Smart Therapy.”

What is really galling is that the Minnesota Department of Human Services (DHS) created an advisory group made up of experts, parents, primary caregivers and people with autism spectrum disorder and related conditions to oversee the EIDBI program.

This advisory group is tasked with “sharing information, answering questions, tackling issues, as well as provide feedback about the EIDBI benefit.” The advisory group holds meetings available to the public that “take into consideration diverse perspectives and needs.” In other words, lots of touchy-feely discussion about how to make the EIDBI service available yet nothing about accounting for the funds paid for those services.

Minnesota isn’t the only state to experience fraud within its Medicaid services. This case just happens to be exceptionally outrageous for the amounts apparently illegally gotten. The problem, of course, is that without oversight it doesn’t take long before real financial fraud occurs.

Imagine in just five short years, the American taxpayers were ripped off of hundreds-of-millions of dollars because no one in state government thought oversight of Medicaid funds was necessary. Had it not been for the employee whistleblower, the taxpayers would be no wiser.

How did the “providers” get away with the fraud? Simple. There was no oversight. The behavioral health community writes the legislation that creates a program like EIDBI and screams that more money and mental health access is necessary. Worse, when the statutes are written, there is no real oversight, and no licensure is required to be a legitimate medical/behavioral caregiver.

Three names come to mind when placing blame. First Jodi Harpstead the Commissioner Department of Human Services in Minnesota, Willie Jett, Commissioner of Education and  Director of Medicaid & MinnesotaCare. Each of these people should have been aware that something strange was happening in the EIDBI program. If Minnesota is like other states, Harpstead would have had to request additional funding from the budget committee each of the years there were increases in the program.

Medicaid funding normally is fifty percent State budget funds and fifty percent federal matching funds. Usually, lawmakers want to know why the increase is needed in a specific program as the legislature will have to increase the budget…requiring more taxpayer funds. Further, what exactly were the questions (and answers) posed by the state budget committee when faced with such an enormous budget increase? And, finally, where were the federal Medicaid representatives? Usually, the feds require monthly extensive reporting and oversight of Medicaid funds. How did Minnesota federal representatives miss such a massive funding increase without serious questions and data to support those hundreds of millions of increased Medicaid dollars? Is the FBI curious about what part the federal Medicaid representatives played in the fraud?

The fact that so many different state and federal departments missed this massive fraud leaves one to wonder if the fraud goes much deeper. The FBI and state inspector generals need to find out how deep the fraud is. And, more importantly, someone in the Minnesota government must examine all the behavioral health programs and providers. That no proof of treatment qualifications was required for the EIDBI program says everything about the subjectivity of behavioral/mental health and how easily the taxpayers can be frauded.

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