TALKING POINT FOR MANY POLITICAL CANDIDATES THIS YEAR.

MINNESOTA'S LOSS OF BILLIONS OF DOLLARS TO MULTIPLE FRAUD SCHEMES IS AT THE CENTER OF THE CONVERSATION.

RECENT CONGRESSIONAL HEARINGS, SUSPENSION OF FEDERAL FUNDS AND TEMPORARY SHUTDOWN OF PROGRAMS HAVE TAKEN AIM AT THE STATE'S MEDICAID PROGRAM.

JOHN CONNOLLY WAS NAMED TEMPORARY DHS COMMISSIONER EARLIER THIS SUMMER, HE'S ALSO THE STATE MEDICAID DIRECTOR.

IT'S GOOD TO HAVE YOU BACK ON THE SHOW.

>> THANKS FOR HAVING ME.

IT'S GOOD TO BE HERE.

>> Cathy: THANK YOU.

A NUMBER OF PROVIDERS HAVE BEEN SUSPENDED.

HAPPY, THOUGH, ARE KIND OF ABOVE -- MANY, THOUGH, ARE KIND OF ABOVE-BOARD PROVIDERS.

I'M KIND OF WONDERING, DO YOU HAVE ANY SENSE OF THE EFFECTS OF THIS ON THE RECIPIENTS?

HOW MANY RECIPIENTS ARE NOT GETTING SERVICES BECAUSE OF THE CRACKDOWN?

>> SO AT THIS POINT WE HAVE GONE THROUGH THE FORMAL REVALIDATION PROCESS, SO THAT'S RE-ENROLLING OR REVIEWING ALL THE PROVIDERS IN THE HIGH-RISK SERVICES THAT WE'VE IDENTIFIED.

THERE ARE 13 OF THEM.

AND ABOUT -- WELL, A MAJORITY OF THEM WERE DISENROLLED AT THE END OF THAT PROCESS FOR GAPS IN DOCUMENTATION, AND BASICALLY THIS IS A PROCESS THROUGH WHICH WE MAKE SURE THAT VERY BASIC REQUIREMENTS ARE IN PLACE.

SO ROOF OF INSURANCE, QUALIFIED PROFESSIONALS, MAKING SURE THAT BACKGROUND CHECKS HAVE OCCURRED, THINGS OF THAT NATURE TO MAKE SURE THAT WE HAVE GOOD ACTORS, SOLID ACTORS IN THE PROGRAM.

SO AT THE END OF THE FIVE-MONTH PROCESS, WE DID DISENROLL ABOUT 60% OF THE PROVIDERS THERE, BUT THEY HAVE AN APPEAL PROCESS THAT'S STILL UNDERWAY NOW.

THE VAST MAJORITY OF THOSE THAT WERE DISENROLLED HAVE APPEALED, AND WE'RE ALREADY THROUGH A THIRD OF THOSE, HAVE APPROVED A THIRD OF THOSE.

SO, MANY OF THEM ARE RE-ENROLLED FULLY IN THE PROGRAM AND PROVIDING SERVICE.

PROVIDERS WERE ABLE TO BILL FOR SERVICES AND CONTINUE DELIVERING SERVICES DURING THAT APPEAL PERIOD AS WELL.

>> Cathy: SO NO ONE HAS FALLEN THROUGH THE CRACKS, IS WHAT YOU'RE SAYING?

>> O, AT THIS POINT WE HAVE NOT ONLY THAT APPEAL PROCESS AVAILABLE TO PROVIDERS SO THEY CAN CONTINUE TO OFFER SERVICE AND BILL FOR SERVICE, BUT ALSO WE HAVE A CONTINUITY OF CARE FRAMEWORK AND TEAM WITHIN DHS THAT WORKS WITH COUNTIES, TRIBAL NATIONS, MCOs TO MAKE SURE THAT IF A PROVIDER STOPS OFFERING SERVICE OR IS TERMINATED FROM THE PROGRAM THAT THERE'S A TRANSITION IN CARE ORCHESTRATED FOR THE MEMBER.

>> Eric: YOU BOOTED 3400 BUSINESSES AND CHARITIES?

IS THAT THE NUMBER?

>> SO, AT THE END OF THE PROCESS, 3400 RECEIVED A NOTICE OF DISENROLLMENT AND THEN THEY HAVE THE OPPORTUNITY TO APPEAL.

>> Eric: TO APPEAL.

>> TO APPEAL THAT DISENROLLMENT.

AND THE VAST MAJORITY, ALL BUT A LITTLE UNDER 200 DID THAT.

WE DID TERMINATE OTHERS FOR OTHER REASONS THAT EITHER DIDN'T RESPOND TO AN EARLIER PROCESS, THINGS OF THAT NATURE, BUT THE VAST MAJORITY DID APPEAL, AND WE'VE ALREADY APPROVED OR REVALIDATED A THIRD OF THOSE.

>> Cathy: I'M WONDERING, HOW DIFFICULT HAS THIS PROCESS BEEN?

I MEAN, IT'S VERY COMPLICATED, OBVIOUSLY.

YOU'RE DEALING WITH THE FEDERAL GOVERNMENT AND PRESSURE FROM THE FEDS.

AND ALSO, YOU KNOW, STATE LAWMAKERS.

SO YOU'RE KIND OF IN THE MIDDLE.

HOW ARE YOU NAVIGATING ALL THAT?

>> IT HAS BEEN, I WILL SAY, AN EXTRAORDINARILY DIFFICULT PROCESS.

SO, FOR CERTAINLY PROVIDERS, FOR PEOPLE IN THE PROGRAM HO HAVE ANXIETY ABOUT WHAT MIGHT BE HAPPENING, FOR THE STAFF IN THE DEPARTMENT, IT HAS BEEN EXTRAORDINARY.

WE HAD FIVE MONTHS TO COMPLETE A PROCESS THAT EVERY OTHER STATE NOW HAS BEEN GIVEN TWO YEARS TO COMPLETE.

AND STAFF HAVE WORKED DAYS, NIGHTS, WEEKENDS.

WE'VE HAD WEEKLY ROUNDTABLES, WEBINARS, OFFICE HOURS, OVER 4,000 CALLS TO PROVIDERS, ONE-ON-ONE TECHNICAL ASSISTANCE.

SO A TREMENDOUS EFFORT, OF COURSE, FROM THE DEPARTMENT, FROM PROVIDERS ALIKE.

AND, OF COURSE, WE'RE NOW EXPERIENCING A DEFERRAL OF $200 MILLION AT THE END OF THIS PROCESS TIED TO PROVIDERS WHO WERE DISENROLLED, EVEN THOUGH THEY WERE ENROLLED AT THE TIME AND APPROPRIATELY BILLING AND OVER A THIRD OF THEM HAVE ALREADY BEEN RE-ENROLLED, BUT THERE'S ALSO, I THINK, A CONCERN ABOUT WHAT METRICS CMS IS USING TO IDENTIFY PROVIDERS WHO ARE SUPPOSEDLY AT HIGH RISK OF FRAUD OR PROGRAM INTEGRITY CONCERN.

AND THEY AREN'T SHARING THAT INFORMATION WITH US, WHICH IS IMPORTANT, BECAUSE WE HAVE PREPAYMENT REVIEW, ENHANCED PREPAYMENT EVIEW IN PROCESS ALREADY AND COULD USE THEIR METHODOLOGY TO STOP FRAUDULENT PAYMENTS FROM GOING OUT TO BAD ACTORS.

>> Cathy: SO I'M WONDERING HERE, WHEN IT COMES TO WHAT HAS BEEN GOING ON, DO YOU FEEL PRETTY CONFIDENT?

I KNOW YOU'RE TEMPORARY COMMISSIONER.

BUT AS YOU CYCLE OUT OF THE JOB BY THE END OF THE YEAR, PROBABLY, DO YOU THINK THAT THE HOUSE IS CLEAN AT THIS POINT OR IS THERE MORE WORK TO DO?

>> SO WHAT I CAN SAY IS, WE HAVE PUT IN PLACE A VARIETY OF DIFFERENT ACTIONS, WHETHER IT BE HIGH-RISK DESIGNATION, WHETHER IT BE TERMINATING -- TERMINATING A PROGRAM THAT WAS OVERWHELMED BY CRIMINALS, ESSENTIALLY, COMMITTING FRAUD, WHETHER IT IS PUTTING PROVIDER ENROLLMENT MORATORIUM IN PLACE, A LICENSING FRAMEWORK FOR AUTISM SERVICES, THE REVALIDATION EFFORT ITSELF AS A PART OF OUR CORRECTIVE ACTION PLAN, THERE HAS BEEN A TREMENDOUS AMOUNT OF ACTIVITY IN ROUGHLY HE LAST TWO YEARS TO TIGHTEN UP THE DIFFERENT CONTROLS IN THE NFRASTRUCTURE THAT WE HAVE TO PREVENT THIS FROM HAPPENING AGAIN.

FROM INVESTIGATING THE FRAUD THAT'S OCCURRED.

SO I THINK IT'S MUCH HARDER NOW THAN IT WAS ALMOST TWO YEARS AGO TO COMMIT FRAUD AGAINST OUR MEDICAID PROGRAM.

BUT FRAUD FIGHTING HAS NO FINISH LINE.

THAT IS ALWAYS GOING TO BE A PROJECT.

IT'S EVER MORE SOPHISTICATED, CRIMINALS ARE EVER MORE SOPHISTICATED SO WE NEED TO KEEP AHEAD OF THEM AND KEEP AT THIS.

>> Cathy: ALL RIGHT.

THANKS FOR THE