EDUCATIONMINNESOTA.ORG.

>> Eric: IN THE NEXT HOUR WE'LL GET AN UPDATE ON RENTAL ASSISTANCE IN ST.

PAUL FROM PIONEER PRESS REPORTER FRED MELO, SOLO ARTIST SARAH MORRIS IS HERE TO PREVIEW HER UPCOMING SHOW AT THE DAKOTA, A DUO OF PROFESSORS ON PRESIDENT TRUMP'S STATE OF THE UNION SPEECH, WHICH INCLUDED PLENTY OF REFERENCES TO MINNESOTA AND FRAUD.

>> Cathy: INDEED.

WE'RE GOING TO START TONIGHT THOUGH WITH HUMAN SERVICES COMMISSIONER SHIREEN GANDHI WHO HAD THE WORD "TEMPORARY" REMOVED FROM HER TITLE EARLIER THIS WORK.

GANDHI OVERSEES THE DEPARTMENT THAT HAS DEALT WITH THE MOST FRAUD IN THE TATE GOVERNMENT.

SHE ALSO OVERSEES THE MEDICAID PROGRAM WHICH IS FACING TEMPORARY AND PERMANENT CUTS IN THE NEXT YEAR.

WELCOME TO THE PROGRAM.

>> YOU WERE TALKING ABOUT -- IN THE DEPARTMENT.

FROM WHAT TO WHAT?

WHAT'S THE PROBLEM WITH THE CULTURE?

>> -- THINGS THAT WE'VE BEEN DOING IN THIS LAST YEAR OF SERIOUS AND INTENSE WORK IS TO GET ALL OF OUR PROGRAM AREAS INVOLVED IN LOOKING AT CLAIMS, MONITORING, SPENDING IN A MUCH DEEPER, CLEARER WAY THAT HELPS US CHANGE, HELPS US SPOT FRIENDS OUTLIERS.

AND ONE OF THE THINGS ALSO THAT'S BEEN A BIG CULTURE CHANGE IS NOT JUST RELYING ON TIPS OF FRAUD, BUT ACTUALLY SORT OF FERRETING OUT THROUGH THE DATA OURSELVES WHAT LOOKS SUSPICIOUS AND LOOKING INTO IT.

>> Cathy: DOES A.I.

HELP WITH THAT BY THE WAY?

>> IT COULD, I DON'T THINK WE'RE USING IT YET.

WE'VE BEEN TALKING ABOUT IT AND I THINK THAT COULD BE AN IMPORTANT ENHANCEMENT IN THE FUTURE.

>> Eric: I JUST WANT TO SHOW VIEWERS WHAT WAS HANDED AT YOUR NEWS CONFERENCE, THE PLAN THAT YOU AND GOVERNOR WALZ HAVE.

ALL OF THIS AND THEN WE WEREN'T ASLEEP AT THE SWITCH.

HERE'S OUR FRAUD REACTION THING.

IT SEEMS PRETTY DAUNTING WITH WHAT, NINE MONTHS EFT TO -- CHARGE POLITICAL -- HOW MUCH OF THIS CAN YOU GET DONE OR IS IT JUST A WISH LIST?

>> YEAH, NOT A WISHLIST.

LIKE I SAID WE'VE BEEN WORKING HARD THIS PAST MORE THAN A YEAR, WORKING HARD IN SO MANY AREAS FROM THE ENHANCED PREPAYMENT REVIEW TO REVALIDATING PROVIDERS IN HIGH-RISK SERVICES, DISENROLLING PROVIDERS.

I THINK WE'RE GOING TO MAKE A LOT OF PROGRESS BY THE END OF THIS YEAR AND WE'LL BE -- MORE TO DO.

YOU CAN'T JUST DECADES OF WHAT I THINK TIM O’MALLEY SAID IN HIS REPORT, DECADES OF NEGLECT, YOU CAN'T CHANGE THAT QUICKLY.

BUT WE'RE MAKING GREAT PROGRESS AND I'M ONFIDENT THAT THE NEXT GOVERNOR AND ADMINISTRATION WILL CONTINUE ON.

>> Cathy: HOW DO YOU EXPLAIN THAT BY THE WAS WAY?

YOU'VE BEEN IN THE DEPARTMENT SINCE 2017 AS A COMPLIANCE OFFICER.

AND THIS, THE FRAUD AS TIM O’MALLEY SAYS HAS BEEN GOING ON FOR DECADES.

YOU HAVE AN UP CLOSE AND PERSONAL LOOK AT THE SYSTEM.

HOW DO YOU, WHAT DO YOU POINT TO IN TERMS OF WHY DID IT GO OFF THE RAILS?

>> I THINK THERE'S A COUPLE THINGS.

ONE, IT'S VERY COMPLEX TO DELIVER HUMAN SERVICES.

NUMBER TWO, THE NUMBERS WAS CHANGING, SO THE GROWTH IN PROGRAMS, GROWTH IN SPENDING CAN BE BECAUSE AN INCREASE IN PEOPLE SERVED, IT CAN BE BECAUSE THE LEGISLATURE INCREASES THE RATES, BILLING RATES, IT CAN BE BECAUSE THE LEGISLATURE CHANGES THE SCOPE OF THE PROGRAMS.

BUT IT ALSO CAN BE BECAUSE OF FRAUD AND THAT'S WHY WE EED BETTER DETECTION >> Eric: HAVE YOU GOT BRAIN DRAIN GOING ON?

I KNOW A COUPLE FINANCIAL PEOPLE LEFT WITH TEN MONTHS LEFT IN THE GOVERNOR'S TERM.

KEY PEOPLE WILL BE LEAVING TO FIND OTHER EMPLOYMENT.

ARE YOU STAFFED UP WELL ENOUGH TO HANDLE THIS?

>> WELL, WE ARE I THINK WE NEED MORE STAFF AND IT'S BEEN VERY HELPFUL THAT THE GOVERNOR AND HIS TEAM HAVE BEEN HELPING US REDEPLOY PEOPLE FROM OTHER AGENCIES TO DHS BECAUSE WE ARE UNDER A TREMENDOUS AMOUNT OF SCRUTINY, BOTH AT THE STATE LEVEL BUT ALSO AT THE FEDERAL LEVEL.

, EXEC THE VICE PRESIDENT THE NEW FRAUD CZAR, $259 MILLION THAT'S BEING HELD IN ADVANCE UNLESS YOU IN 60 DAYS SHOW YOU'RE SERIOUS ABOUT FRAUD CONTROL.

>> YEAH.

THAT'S INTERESTING BECAUSE WE HAVE BEEN ON THIS JOURNEY FOR MORE THAN A YEAR OF SERIOUS AND INTENSE WORK TO CRACK DOWN IN FRAUD IN MEDICAID.

SO THAT'S, IT'S KIND OF AN ODD STATEMENT.

BUT WE ARE, YOU KNOW, WE TAKE VERY SERIOUSLY, WE'RE DOING EVERYTHING WE CAN TO SHOW THAT ALL OF THOSE CLAIMS ARE LEGITIMATE AND GET THE MONEY BACK.

AND IF THEY'RE NOT LEGITIMATE THEN WE WILL GO AFTER THOSE PROVIDERS FOR THAT MONEY.

>> Cathy: SO ERIC HAD THE LEGISLATION HERE, DO YOU REALLY NEED THE LEGISLATURE TO DO ALL THAT OR WHAT CAN YOU DO ON YOUR OWN TO CLEAR THINGS UP?

>> YEAH, WE'VE BEEN DOING -- FRAUD ON OUR OWN AND THIS IS THE PARTNERSHIP WE NEED FROM THE LEGISLATURE.

THERE'S A LOT OF PLAYERS IN THE HUMAN SERVICES SPACE, IT'S NOT JUST DHS.

WE HAVE DHS, WE HAVE THE COUNTIES, WE HAVE MANAGED CARE ORGANIZATIONS.

AND THEN THE LEGISLATURE THAT MAKES THE LAWS AND DESIGNS THE PROGRAMS.

AND SO WE HAVE TO DESIGN THE PROGRAMS BETTER ON THE FRONT END.

DHS HAS TO STRENGTHEN ITS INTERNAL CONTROLS THROUGHOUT THE PROCESS AND BETTER PREPAYMENT REVIEW, POST-PAYMENT REVIEW, THE A.I.

THAT YOU TALKED ABOUT TO HELP US CATCH THIS.

BECAUSE WE HAVE SO MANY CLAIMS GOING THROUGH OUR SYSTEM EVERY YEAR.

>> Eric: AND IT'S 2 BILLION -- 1.2 MILLION PEOPLE THAT ARE AFFECTED?

>> 1.2 MILLION PEOPLE AND OUR MEDICAID PROGRAM IS $20 BILLION, STATE AND FEDERAL FUNDS.

>> Cathy: DOES IT HELP TO HAVE BROKEN UP DHS INTO THREE DIFFERENT GROUPS IN A SENSE?

>> YES, YES, I THINK THAT'S BEEN VERY HELPFUL TO HAVE A FOCUSED MEDICAID AGENCY AND NOT HAVE THE COMMISSIONER NEEDING TO PAY ATTENTION ALSO TO CHILDREN, YOUTH, AND FAMILIES, AND THEN THE INTENSIVE NEEDS OF DIRECT CARE AND TREATMENT, THE STATE'S MENTAL HEALTH HOSPITAL SYSTEM.

MUCH BETTER TO BE A FOCUSED