Adult Companion Services
Mixed caseCompanion care appears in mixed HCBS allegations, including Guardian Home Health and a 2026 state takedown. No service-only loss figure is isolated.
Programs & controls · 14 high-risk Medicaid service categories
High-risk is a control label. It is not a verdict.
Minnesota has placed 14 Medicaid service categories under heightened program-integrity scrutiny. Some have dedicated criminal cases. Some appear only inside mixed-service allegations. Others have no dedicated fraud prosecution located in the current public record. This page keeps those categories separate.
01 · The service map
Fourteen programs. Different evidence.
A service can be high-risk because of weak controls, unusual billing, rapid growth, known fraud patterns or other vulnerabilities. That designation should never be read as a claim that every provider or recipient is fraudulent.
Adult Day Services
No dedicated case locatedNo dedicated Minnesota Medicaid-billing prosecution was located in the current research pass.
Adult Rehabilitative Mental Health Services (ARMHS)
Dedicated casesCurrent state charges include the Reva Health matter and a separate mixed-service case. Charged amounts remain allegations unless adjudicated.
Assertive Community Treatment (ACT)
No dedicated case locatedDHS is reviewing payment policy and rate methodology with a program-integrity lens; no ACT-specific fraud prosecution was located.
Community First Services and Supports (CFSS)
No dedicated case locatedCFSS is still replacing PCA. Older PCA cases should not be relabeled as CFSS fraud.
Early Intensive Developmental and Behavioral Intervention (EIDBI)
Multiple casesFederal autism-service prosecutions include Smart Therapy and Star Autism matters. Published billed, paid and provider-specific figures overlap and cannot be added into one clean loss total.
Housing Stabilization Services (HSS)
Program endedMultiple federal case waves followed rapid growth and weak controls. HSS ended October 31, 2025; several defendants have since pleaded guilty.
Individualized Home Supports (IHS)
Dedicated + mixedHealey Homes is a dedicated federal case; Guardian Home Health includes IHS inside a broader HCBS allegation.
Integrated Community Supports (ICS)
Dedicated caseThe Ultimate Home Health federal case alleges high-hour ICS billing for services not provided. Program spending is not itself a fraud total.
Intensive Residential Treatment Services (IRTS)
No dedicated case locatedNo IRTS-specific fraud prosecution was located. DHS is reviewing IRTS payment policy and rate methodology.
Night Supervision Services
Mixed caseOvernight billing appears in the Guardian Home Health complaint, but no standalone Night Supervision scheme total is stated.
Nonemergency Medical Transportation (NEMT)
Dedicated caseThe Driving Miss Daisy case alleges more than $1.4 million in false NEMT billing. DHS also began new NEMT claims-compliance reviews in August 2026.
Recovery Peer Support
No dedicated case locatedNo service-specific criminal fraud prosecution was located. Current law contains billing restrictions and monetary-recovery tools.
Recuperative Care
No dedicated case locatedA newer Medicaid service with enhanced screening and universal prior authorization beginning August 1, 2026; no dedicated fraud prosecution was located.
“No dedicated case located” does not mean “no fraud exists.” It means the current public research corpus does not contain a service-specific prosecution that clears the sourcing bar.
Primary overview: Minnesota DHS Program Integrity
02 · What changed
The control response is now statewide.
Prosecution is only one layer. Minnesota and CMS are also changing enrollment, revalidation, payment review and service authorization. Those actions can prevent losses, but they can also slow legitimate care.
3,070 providers revalidated
DHS reported 3,070 high-risk providers revalidated as of August 12, with 1,627 appealing disenrollment, 128 choosing termination instead of revalidation, and 660 terminated after their appeal windows closed.
Moratoria remain in force
Twelve high-risk service categories are under a CMS-approved new-provider enrollment moratorium through January 27, 2027. EIDBI has a separate moratorium; HSS is closed.
Claims can be stopped before money leaves
Enhanced fee-for-service pre-payment review is now part of the corrective-action framework. A flagged claim is not the same as a proven fraudulent claim.
New claims reviews began Aug. 24
DHS announced provider-claim compliance reviews for nonemergency medical transportation. Selection for review is not an accusation.
Controls are affecting authorization speed
DHS reported longer-than-required EIDBI authorization timelines in August because review volume increased. Stronger control can create a legitimate access problem if review capacity does not keep pace.
Prior authorization became universal
All recuperative-care services require prior authorization beginning August 1, 2026. A denial or request for more documentation should not be counted as fraud.
Control success needs two measures
A fraud-control program is not successful merely because it blocks more claims. The public should eventually be able to see both integrity outcomes—recoveries, verified improper billing, prosecutions—and access outcomes such as authorization delays, provider exits and service availability.
03 · Scale without inflation
Large programs produce large numbers. Context still matters.
DHS says Minnesota Medicaid paid about $20.9 billion to roughly 40,000 provider organizations in 2024 and served about 1.2 million people in an average month. Those figures describe program scale, not a fraud denominator.
$20.9B paid to providers
Statewide Medicaid program spending. It should not be multiplied by a suspicion rate or used as a proxy for stolen money.
~40,000 organizations
The statewide provider universe is much larger than the providers subject to criminal cases or sanctions.
~1.2M monthly recipients
Program-integrity reforms affect a public benefit used by a large share of Minnesotans; access consequences therefore belong in the accountability story.
Keep going
Programs are only one layer.
Follow the money separately, then see which institution actually had which legal authority.
MoneyWhat has actually been recovered?Separate judgments, restitution, settlements, identified recoveries, potential recoveries and cost avoidance.
AuthorityWho could do what?DHS payment controls, AG/MFCU prosecution, county attorneys, BCA referrals and the 2019 CCAP change.
OversightWhat did institutions know?Warnings, auditor findings, agency responses and reforms.