Minnesota is advancing efforts to strengthen Medicaid anti-fraud systems. The Department of Human Services, working with Optum, has completed the first phase of a one-year project to develop an automated pre-payment review system for Medicaid claims. Over the past 90 days, Optum reviewed nearly four years of claims in 14 high-risk service areas, flagging items that need additional review before payment.

Officials say the work is not a measure of fraud but identifies areas where policy clarification or provider training may be needed. Over the next nine months, the state will refine the system to reduce fraud risk, improve efficiency, and investigate suspicious activity when necessary.

For more information on Minnesota’s Medicaid program integrity efforts, visit the state’s Medicaid program integrity webpage.