Minnesota human services department investigating 15 autism providers

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The state of Minnesota is investigating 15 autism providers and has already completed other investigations, withheld payments due to credible fraud allegations and forwarded cases to law enforcement “when appropriate,” according to the Minnesota Department of Human Services.

DHS said in a statement that these investigations “follow a national trend of identifying fraud in Medicaid-funded autism services.” DHS administers Minnesota’s version of Medicaid, known here as Medical Assistance, which is a federal-state health plan for poor and disabled people.

The Reformer reported in mid-June that the FBI is investigating possible fraud in Minnesota’s autism program, which has exploded in growth since launching in mid-2015.

The number of providers — who diagnose and treat people with autism spectrum disorder — has increased 700% in the past five years, climbing from 41 in 2018 to 328 last year. The amount paid to providers during that time has increased 3,000%, from about $6 million to nearly $192 million — according to DHS data.

“DHS has systems in place to identify fraud, waste and abuse, and the agency takes swift action when we suspect or find it,” the agency said in a statement to the Reformer . “Early identification and access to services are life-changing for people with autism – especially children. That’s why it’s so important to make sure every dollar spent on services is accounted for.”

Minnesota doesn’t license autism centers, but DHS is studying the prospect. When autism providers enroll for reimbursement through Medical Assistance, DHS verifies that they have the appropriate credentials. But beyond that, DHS is not out in the field checking in on what’s happening in autism centers.

Idil Abdull is a Somali-American immigrant whose son has autism, which led her to become an advocate, open an autism therapy agency and co-found the Somali American Autism Foundation of Minnesota.

She and other Somali parents of children with autism fought for years to get the state Medicaid program to pay for intensive, one-on-one treatment called Applied Behavior Analysis for low-income children. Prior to that, the state subsidized treatment for wealthier families but denied it to low-income children in managed care plans.

ABA is a science-based approach that takes more hours of therapy, and thus higher reimbursement.

Lawmakers passed legislation this year to license behavior analysts — joining 34 other states — and increase reimbursement rates 15% for early intensive developmental and behavioral intervention providers to address high turnover and help providers maintain financial stability.

Abdull said she opposed licensing behavior analysts but supports licensing autism centers.

“I like rules because these are vulnerable kids; they can’t speak for themselves,” Abdull said.

But, she added, DHS needs to better train and oversee all autism centers and families — fairly and equitably.

Autism division short-staffed

Meanwhile, DHS is grappling with vacancies in the autism division: Three of the division’s four employees left in recent months. The agency said other qualified staff are helping support the division while DHS fills the vacancies.

“There have been no significant gaps to the core function and services of the program,” DHS said in a statement.

One of the people who left is Rep. Kim Hicks, DFL-Rochester, who was the policy lead for the autism program at DHS, where she began working in September 2018. Prior to that, she was a disability advocate for a decade.

Hicks said she resigned from the autism job in January and took a new role at DHS as an administrator in a grants division because she struggled with the dual roles of executive and legislative branches.

“Because I’m a legislator, it gets complicated,” she said.

Hicks, elected in 2022, said she ran in part to provide the Legislature expertise in autism services; most of her bills relate to disability services.

Hicks, who emphasized she was not speaking for DHS, said she’s concerned about autism centers and supports the Legislature’s human services chairs, who have requested more information from DHS about the safety and quality of autism centers in light of a WCCO story about abuse in a center.

“I’m an autism mom, so it’s very near and dear to my heart,” she said. “You have to think about fraud, waste and abuse as a whole collective thing.”

Safety, oversight and supervision are intertwined, she said, so she worries about children not getting quality services.

“There are no standards for the facilities,” Hicks said. “There’s no licensing requirements for the support workers. There’s no licensing visits. There’s no licensing reports. There’s no licensing.”

Only the DHS Office of Inspector General goes out to the autism centers to investigate suspected fraud. The OIG can stop providers’ ability to bill, and fraud findings can be forwarded to the attorney general’s Medicaid Fraud Unit for prosecution.

Hicks said she plans to focus on autism centers next session because of the importance of effective, early intervention.

“And it’s a really hard job,” she said, “and so I just want to make sure that the people who are doing the really hard job are doing it in a way that helps children and doesn’t cause harm.”

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