Autistic children paid the price (twice) for fraud in Minnesota

Children are the ultimate victims of Medicaid fraud in Minnesota, specifically the $20 million in fraudulent billing reported by the Justice Department for services for children with autism.

They’re the victims not once, but twice, because many never received critical early intervention resources, and now a state-wide crackdown has disrupted legitimate services.

This April, during Autism Awareness Month, the Minnesota Department of Human Services (DHS) is working to prevent fraud and get necessary services to Minnesotans who need them.

“They will steal time from you and your kids,” said James Clark, DHS inspector general. He is spreading a message of vigilance targeting entities and individuals who overbilled, offered kickbacks, hired unqualified staff, forged credentials, and employed a whole host of other methods of deceit to make money. “It makes me sick and sad,” Clark said, adding that autistic children and adults in Minnesota are paying the price.

The DHS defines autism spectrum disorder as a developmental disorder characterized by differences in social interaction and communication, as well as restricted and repetitive patterns of behavior, interest, or activities. Autism can be diagnosed as early as 18 to 24 months. According to the National Institutes of Health, early diagnosis and intervention for autism is critical because a young child’s brain has high plasticity, allowing therapies to better shape neural connections, improve communication and social skills, and boost cognitive development.

“This is early, intensive, skills-based, and activities-based communication that helps foster social and emotional skills,” Clark described. Federal investigations at several Minnesota autism centers revealed that some providers billed for intensive one-on-one therapy while actually providing little more than basic supervision or babysitting. “These kids were supposed to be receiving autism services.”

Clark added that the most common fraud scheme DHS saw across all the programs is billing for more services than were actually provided. “So, you get a check-in for 15 minutes a day or a couple of hours a day, yet the provider is billing the state or health insurance 10, 12, 13 hours of services a day,” Clark explained.

He said, in some cases, the buck can stop with parents who carefully review their bill’s explanation of benefits to make sure it matches the services received. Clark and DHS are working hard to help parents and Minnesotans stay vigilant, and both understand and look out for signs of fraudsters when it comes to autism services in the state. Clark said that means asking lots of questions of a provider. “Does it look like this is evidence-based and clinically based? Do their records look legitimate, like health care records? Are they keeping track and monitoring your child’s progress,” Clark asked.

DHS is asking Minnesotans seeking autism services do the following:

1.      Educate Yourself

Understand what services your autistic child needs, what these services entail, and read up on public health care programs in Minnesota that offer a benefit called Early Intensive Developmental and Behavioral Intervention, or EIDBI. For more information on medically necessary EIDBI services, see the EIDBI 101 for Families training.

EIDBI is an individualized evidence-based behavioral or developmental intervention delivered in the child’s natural environments (home, school, community). These programs are supervised by licensed and qualified professionals who focus on skill building across areas like communication, social skills, daily living, and behavior. Parents are partners in this work, which is highly transparent.

2.      Network

Talk to trusted doctors, licensed professionals, teachers, social workers, and people in your community for referrals to legitimate autism providers.

3.      Trust Your Gut

If something about your provider seems off, report it. Ask questions like: Does this provider seem reputable, clean, and safe? Does the staff seem knowledgeable and competent when I ask questions? Are they taking the time to explain what the service looks like and the impact on my child?

4.      Watch for the Red Flags

·       Cash, gift cards, free food delivery services, transportation money, or other incentives or kickbacks are a tip-off that the provider is likely fraudulent. Accepting these incentives is a crime.

·       Be very skeptical of a provider pressuring you with sales tactics. Medical benefits are geared toward the consumer who makes an informed choice.

·       Services billed that didn’t occur, were provided by unqualified staff, or included extra hours/sessions. Read your explanation of benefits closely.

·       No clear plan or measurable goals

·       Little or no communication from the provider

·       Frequent staff turnover or insufficient supervision

·       Rigid programming that ignores the child’s interests or needs

·       Overemphasis on compliance instead of skill building

5.      Report Concerns

Contact DHS right away if something seems off. You do not need to be certain of a crime to make a report.

·       Report suspected fraud online at mn.gov/dhs/report-fraud

·       Call the DHS fraud hotline at 651-431-2650 or 1-800-657-3750