Optum fraud report: big drop in Medicaid spending

From KSTP-5 TV,

Outside audit finds ‘recurring vulnerabilities’ with Minnesota Medicaid system.

Details,

The report estimates more than $1.7 billion in Medicaid payments that need a closer look to see if there were possible issues, including whether there were appropriate claims for service.

That’s billion, with a “b”.

So much euphemism. “Vulnerabilities,” “issues,” “appropriate,” “concerns,” “improper.” Everything but the word fraud.

The report itself can be found here (link courtesy of Minnesota Reformer). Notice that I said “found” instead of “read.” This nine-page segment, for example, has entire pages completely redacted. Presumably, that’s to prevent fraudsters from learning of more vulnerabilities in the system not yet made public.

The word “fraud” appears only rarely in the report, which is written in consultant-speak. Optum looked at more than $9 billion in payments across 14 separate Medicaid programs to some 7,700 providers.

Deep in the report is a remarkable table showing the drop in Medicaid payments across these 14 programs between the 3rd and 4th quarters of 2025. Payments dropped by 29 percent ($166 million) as the state began to crack down on waste fraud and abuse.

Call it the anti-fraud dividend. In about a month, we will see a new budget forecast for the state of Minnesota, I hope the anti-fraud work will make a significant dent.

We need more, and faster.