Medical Assistance Fraud in Minnesota

Accused of Violating Minn. Stat. § 609.466? A Minnesota Attorney Explains Your Medical Assistance Fraud Charges

The letter arrives from the Minnesota Department of Human Services, and your world tilts on its axis. It’s dense with bureaucratic language, referencing statutes and investigations you never imagined would apply to you. Or perhaps the first notice you received was a knock on the door from an investigator. However it began, you now find yourself in a terrifying and isolating position: being accused of Medical Assistance fraud. You run a clinic, a home healthcare agency, a transportation service, or a therapy practice. You deal with a mountain of paperwork, complex billing codes, and constant regulatory changes. You didn’t set out to defraud anyone, yet you are now staring down a criminal charge that threatens not just your freedom, but your entire career and reputation.

The accusation itself feels like a conviction. The state paints you as a criminal who intentionally stole from the public. They don’t see the long hours, the confusing rules, or the simple human errors that can occur in any complex billing system. They only see a false claim and an opportunity to make an example out of you. In this moment, it’s easy to feel overwhelmed and alone, as if the full weight of the state government is crashing down on you. But you are not alone, and an accusation is not a guilty verdict. I have dedicated my practice to defending people just like you across the entire state of Minnesota—from the bustling medical centers of Minneapolis and Rochester to community clinics in St. Paul, Duluth, and St. Cloud. I understand the immense pressure you’re under, and I am here to help you fight back. You don’t have to face this alone.

The Reality Behind a Minnesota Medical Assistance Fraud Accusation

In Minnesota, a charge of Medical Assistance (MA) fraud isn’t about a simple mistake or a typo on a form. Prosecutors must prove that you acted with a specific “intent to defraud.” This means they believe you knowingly and deliberately submitted false information to the state to get money you weren’t entitled to receive. These cases often arise from complex billing practices, where the line between an honest error and intentional deception can seem blurry to an outsider. You might be accused of “upcoding” services, billing for appointments that never happened, or submitting inaccurate cost reports for your agency. The state will comb through years of your records, looking for patterns they can spin into a narrative of criminal intent.

Facing a Minnesota Medical Assistance fraud accusation means you are up against a powerful state agency and determined prosecutors. These are not your typical criminal charges. They involve a deep understanding of healthcare regulations, billing software, and the inner workings of the Minnesota Department of Human Services. Common scenarios can range from a Minneapolis-based home healthcare agency being accused of billing for phantom employee hours to a St. Paul clinic allegedly misrepresenting the types of services provided to get higher reimbursement rates. No matter the specifics of your situation, the core of the state’s case will be trying to prove that you knew what you were doing was wrong. My job is to dismantle that narrative.

Minnesota Law on Medical Assistance Fraud — Straight from the Statute

The legal foundation for your charge is found in a specific state law. The prosecutors are using this exact language to build their case against you. Understanding the statute is the first step in understanding the fight ahead.

The controlling law is Minnesota Statutes § 609.466. It states:

“Any person who, with the intent to defraud, presents a claim for reimbursement, a cost report or a rate application, relating to the payment of medical assistance funds pursuant to chapter 256B, to the state agency, which is false in whole or in part, is guilty of an attempt to commit theft of public funds and may be sentenced accordingly.”

Breaking Down the Legal Elements of Medical Assistance Fraud in Minnesota

For the state to convict you of Medical Assistance fraud, a prosecutor must prove every single one of the following legal elements beyond a reasonable doubt. If I can show that the state’s evidence on even one of these points is weak or nonexistent, their entire case can fall apart. This is where a strong defense begins.

• Presenting a Claim, Cost Report, or Rate ApplicationThis is the foundational action. You, or someone working for you, must have submitted a request for payment to the state. This could be an invoice for patient services, a detailed annual cost report for your facility, or an application to set the rates the state will pay you. The “presentation” can be electronic or on paper. The prosecutor will produce the specific documents they allege are fraudulent, and our first job is to scrutinize their origin, their accuracy, and who was actually responsible for submitting them.
• The Information Was FalseThe state must prove that the claim, report, or application you submitted contained factually untrue information. This isn’t about a difference of opinion; it must be a concrete falsehood. Examples include billing for a 60-minute session that only lasted 30 minutes, claiming a more complex and expensive procedure was performed than the one that actually occurred (upcoding), or listing expenses on a cost report that your business never incurred. The falsity must be material—a simple typo on a patient’s address likely doesn’t count, but a falsified date of service does.
• Intent to DefraudThis is the most critical element and often the centerpiece of a successful defense. The prosecutor cannot win by simply showing a mistake was made. They must prove, with evidence, that you knew the information was false and that you submitted it with the specific goal of deceiving the state to obtain money you were not owed. Honest mistakes, confusion over byzantine billing codes, software glitches, or a lack of proper training are not the same as criminal intent. Your state of mind is everything.
• Relating to Minnesota Medical Assistance (MA)The alleged fraud must specifically target Minnesota’s Medical Assistance program, which is governed by Chapter 256B of the state statutes. This program, also known as Medicaid, provides healthcare for low-income Minnesotans. If the billing dispute involves a private insurer or Medicare, a different set of laws and regulations would apply. The charge under § 609.466 is exclusively about funds administered by the state’s MA program, and the prosecution must show a direct link to this specific funding source.

Penalties for a Medical Assistance Fraud Conviction in Minnesota Can Be Severe

Because Minnesota law treats MA fraud as an “attempt to commit theft of public funds,” the penalties you face are tied directly to the dollar amount the state claims you attempted to steal. A conviction is not just a slap on the wrist; it can lead to prison time, crippling fines, and the complete destruction of your professional life. Understanding the stakes is critical.

Felony Level Penalties

If the value of the alleged fraud is more than $5,000, you will be charged with a felony. A conviction can carry a sentence of up to 10 years in prison, a fine of up to $20,000, or both.

If the value is between $1,001 and $5,000, it is also a felony, punishable by up to 5 years in prison, a fine of up to $10,000, or both. Beyond prison and fines, a felony conviction means losing your civil rights, including the right to own a firearm.

Gross Misdemeanor Penalties

For alleged fraud valued between $501 and $1,000, you will face a gross misdemeanor charge. The maximum penalty is up to one year in jail and a fine of up to $3,000. While not a felony, a gross misdemeanor is a serious crime that will leave you with a permanent criminal record.

Misdemeanor Penalties

If the amount is $500 or less, the charge is a misdemeanor. This carries a maximum penalty of 90 days in jail and a $1,000 fine. Even a misdemeanor conviction can have a lasting negative impact on your career and background checks.

What Medical Assistance Fraud Looks Like in Real Life — Common Scenarios in Minnesota

These charges rarely stem from a single, obvious act of theft. More often, they are the result of patterns discovered during audits, which investigators then label as intentional fraud. You may recognize your own situation in these common Minnesota scenarios.

The Overwhelmed Minneapolis Clinic Manager

You manage a busy clinic in Minneapolis with a dozen providers. A billing employee, who you later discover was poorly trained, consistently used the wrong codes for certain procedures, resulting in higher-than-allowed reimbursements from MA. An audit flags this pattern, and investigators don’t see an overworked manager and a struggling employee; they see a conspiracy to defraud the state. Now, you are being held personally responsible for systemic errors you didn’t even know were happening.

The Duluth Home Healthcare Agency Audit

Your home healthcare agency provides vital services to vulnerable adults in the Duluth area. You bill for hours your staff spends with clients. During an audit, the state finds discrepancies between your billed hours and your employees’ timesheets. They allege you systematically billed for services that were never rendered. They aren’t interested in the fact that your staff often performs unbillable tasks or that your software sometimes glitches. They simply see a dollar amount and accuse you of theft.

The Rochester Transportation Provider

Your company provides non-emergency medical transportation for MA recipients in the Rochester area, taking them to crucial appointments. The state accuses you of billing for trips that never happened or for using an inappropriate level of service. You believe your records are accurate, but the state’s investigators are using data analytics to flag what they consider “suspicious” patterns, and now you have to prove you are not a criminal.

The St. Paul Therapist and “Upcoding”

As a therapist in St. Paul, you provide a range of mental health services. The state claims you engaged in “upcoding”—billing for 60-minute therapy sessions when you only provided 45-minute sessions. You know that sessions can run long or short, and your billing reflects the complexity of the service, not just a stopwatch. But the prosecutor presents a simple, damning chart showing a pattern of alleged overbilling, and suddenly your professional judgment is on trial.

Legal Defenses That Might Work Against Your Medical Assistance Fraud Charge

When you are accused of a crime defined by your intent, your defense must be built around dismantling the prosecution’s claims about what you were thinking. A charge is merely an allegation, a story that the government is trying to tell. My job is to tell your side of the story and introduce the doubt that the law requires. We will meticulously review every piece of evidence—every email, every billing entry, every patient file—to find the weaknesses in the state’s case. An error is not fraud. A misunderstanding is not theft.

Your defense must be tailored to the unique facts of your case. We will not rely on generic arguments; we will build a strategy designed to expose the flaws in the prosecutor’s specific allegations against you. Whether you are in Plymouth, Maple Grove, or anywhere else in Minnesota, the core principles of a strong defense remain the same: challenge intent, question the evidence, and hold the state to its burden of proof.

Lack of Intent to Defraud

This is the cornerstone of many successful MA fraud defenses. The state must prove you knowingly and willingly intended to deceive them. We can fight this head-on.

• Honest Mistake or Clerical Error: We can demonstrate how the alleged “fraud” was nothing more than a simple human error made by you or an employee. In high-volume billing operations, mistakes are not only possible but statistically likely.
• Complex and Confusing Rules: Minnesota’s Medical Assistance billing regulations are notoriously dense and subject to change. We can argue that you made a good-faith effort to comply with rules that a reasonable person would find ambiguous or confusing.
• Reliance on Software or a Billing Service: Many providers rely on third-party software or billing companies. We may be able to show that the errors originated with this third party and that you had no knowledge that the claims being submitted on your behalf were false.

Insufficient Evidence

You are presumed innocent. The burden is entirely on the prosecutor to prove their case. I will hold them to that burden by aggressively challenging the quality and sufficiency of their evidence.

• Inconclusive Audit Findings: Government audits are not infallible. We can hire our own forensic accountants and billing experts to conduct an independent review of your records to find evidence that contradicts the state’s conclusions.
• Unreliable Witness Testimony: The state’s case may rely on a disgruntled former employee or another individual with a motive to lie. I will rigorously cross-examine these witnesses to expose their biases and challenge their credibility.
• Chain of Custody Issues: The state must be able to prove who submitted the false claim. In a large office in Brooklyn Park or a hospital system in Eagan, dozens of people may have access to billing systems. We can argue that the state cannot prove you were the one who knowingly submitted the fraudulent document.

Good Faith Belief in Accuracy

This defense is related to intent, but focuses on your sincere belief that the claims you submitted were legitimate and accurate at the time.

• Reliance on Professional Advice: If you were following the guidance of a consultant, accountant, or other professional regarding your billing practices, we can argue that you acted in good faith based on that advice.
• Standard Industry Practice: We may be able to demonstrate that your billing methods, while questioned by the state, are actually common and accepted practices within your specific healthcare field in Minnesota.

Entrapment or Misleading Government Conduct

While less common, it is possible that government investigators crossed a line.

• Vague or Misleading Guidance: If you can show that you sought clarification from the Department of Human Services about a billing issue and received incorrect or confusing advice, we can argue that the government contributed to the error.
• Improper Investigative Techniques: If investigators used deception or coercion to induce you into making a statement or committing an act you otherwise would not have, it may form the basis of a defense.

Minnesota Medical Assistance Fraud FAQs — What You Need to Know Now

What exactly is Minnesota Medical Assistance (MA)?

Minnesota Medical Assistance is the state’s Medicaid program. It is a government-funded health insurance program for low-income individuals and families, people with disabilities, and the elderly. It is administered by the Minnesota Department of Human Services (DHS), and the rules are found in Chapter 256B of the Minnesota Statutes.

Will I go to jail for Medical Assistance Fraud in Minnesota?

It is a very real possibility, especially if the alleged fraud involves a high dollar amount. Felony-level charges (over $1,000) carry potential prison sentences of 5 to 10 years. However, a skilled defense attorney can fight for alternative outcomes, such as having the charges reduced or dismissed, or negotiating a resolution like probation or diversion that avoids incarceration.

Can a Medical Assistance Fraud charge be dismissed?

Yes. A dismissal is one of the best possible outcomes. I can work to get your case dismissed by showing the prosecutor that they have insufficient evidence to prove their case, that your rights were violated during the investigation, or by successfully arguing a pre-trial motion to have evidence suppressed.

Do I need a lawyer for a fraud charge in St. Paul?

Absolutely. A Medical Assistance fraud charge is not a traffic ticket or a minor offense. You are facing a complex criminal charge that could end your career and land you in prison. You need a defense lawyer who understands the specific laws, the science of forensic accounting, and the tactics of state prosecutors in Ramsey County and across Minnesota.

What’s the difference between a mistake and fraud?

The difference is intent. A mistake is an unintentional error, like a typo or a misunderstanding of a rule. Fraud, under Minn. Stat. § 609.466, requires the state to prove beyond a reasonable doubt that you knew the claim was false and submitted it with the specific purpose of deceiving the state for financial gain.

How long does a fraud charge stay on my record in Minnesota?

A criminal conviction is permanent. While Minnesota law allows for the expungement (sealing) of some criminal records, the process is complex and not guaranteed. A conviction for MA fraud, especially a felony, can be a lifelong barrier to employment, housing, and professional licensing. The best strategy is to fight the charge aggressively from the start to avoid a conviction in the first place.

I run a clinic in Minneapolis; am I responsible for my employee’s billing errors?

Potentially, yes. Under various legal doctrines, a business owner or manager can be held responsible for the actions of their employees. The state may try to argue that you implicitly approved of the conduct or were “willfully blind” to it. A key part of your defense will be to show you had proper compliance procedures in place and no knowledge of any wrongdoing.

What happens to my professional license if I’m convicted?

A conviction for MA fraud will almost certainly trigger a review by your professional licensing board (e.g., the Board of Medical Practice, Board of Nursing). This can lead to suspension or even permanent revocation of your license to practice in your field, effectively ending your career.

Can I be charged if I never actually received any money?

Yes. The statute defines the crime as an “attempt to commit theft.” The law punishes the act of submitting the false claim with fraudulent intent, regardless of whether the state actually paid it. The fact that the fraudulent claim was caught before payment is not a defense.

What should I do if investigators from the Minnesota Department of Human Services contact me?

You should not, under any circumstances, speak with them or provide them with any documents without your lawyer present. Be polite, but firm. State that you have an attorney (or are in the process of hiring one) and that all future communications must go through them. Anything you say can and will be used against you.

Is this a state or federal charge?

The charge under Minn. Stat. § 609.466 is a state-level criminal charge, prosecuted by county attorneys in Minnesota. However, large-scale healthcare fraud can also trigger a parallel investigation by federal authorities (like the FBI and HHS-OIG), which can lead to separate federal charges.

Can this be resolved without a trial?

Yes, many criminal cases are resolved before trial. As your attorney, I would explore all possible avenues. This could include negotiating with the prosecutor for a dismissal, a favorable plea agreement to a lesser charge that protects your career, or entry into a diversion program that results in the charges being dropped after a period of compliance.

What are the first steps in building a defense?

The very first step is to hire an experienced Minnesota criminal defense attorney. The second step is a thorough and privileged consultation where you tell me everything that happened. From there, we will conduct our own investigation, analyze the state’s evidence, and begin building a strategic defense tailored to the facts of your case.

How is the “value” of the fraud determined?

The value is the total dollar amount the state alleges you attempted to obtain through false claims. Prosecutors will often aggregate dozens or even hundreds of small claims over a period of years to reach a felony-level threshold. Part of my job is to challenge this calculation and argue for a lower amount.

What is a “cost report” in the context of MA fraud?

For many institutions like nursing homes or group homes, Medical Assistance reimbursement rates are based on annual “cost reports” they submit detailing their expenses. Allegations of fraud can arise from accusations of inflating labor costs, misrepresenting capital expenses, or including personal expenses as business costs on these reports.

What a Medical Assistance Fraud Conviction Could Mean for the Rest of Your Life

The consequences of a conviction extend far beyond the courtroom walls. They will follow you for the rest of your life, creating permanent barriers to the future you thought you had. This is not just about jail time or a fine; it’s about a fundamental change to your status in society.

Your Professional License and Career in Ruins

For any licensed healthcare professional—a doctor, nurse, chiropractor, therapist, or pharmacist—a conviction for MA fraud is a career-ending event. Your licensing board will see the conviction as a profound breach of professional ethics. You will almost certainly face disciplinary action, which can range from a lengthy suspension to the permanent, irrevocable loss of your license. Without your license, the profession you spent years training for is gone forever.

The Permanent Shadow of a Criminal Record

A conviction, especially a felony, creates a permanent public record of your guilt. This record will appear on every background check for the rest of your life. It can prevent you from getting a new job, particularly in any field related to healthcare, finance, or government. Landlords may deny you housing, and banks may refuse you loans. You will be forced to check “yes” on the conviction box on applications, a single mark that often leads to immediate rejection.

Exclusion from All Government Healthcare Programs

A state MA fraud conviction will almost certainly lead to your name being placed on the federal Health and Human Services (HHS) OIG Exclusion List. This legally bars you from participating in any federal healthcare program, including not just Medicaid but also Medicare. No hospital, clinic, or practice that accepts federal funds can employ you in any capacity, not even in an administrative role. This effectively blacklists you from the vast majority of the American healthcare industry.

Financial Devastation Through Restitution and Fines

In addition to criminal fines, the court will order you to pay full restitution to the state for any amount they are found to have lost. But it doesn’t stop there. The government can also pursue separate civil actions against you, seeking massive monetary penalties that can be double or even triple the amount of the original fraud. This can lead to financial ruin, bankruptcy, and the seizure of your assets.

Why You Need a Tough, Experienced Minnesota Medical Assistance Fraud Attorney

When the state has you in its sights, you cannot afford to go it alone or hope for the best. The prosecutors who handle these cases are skilled, well-funded, and specialize in this complex area of law. You need a defender in your corner who can meet them on equal footing.

You Need a Defender Who Understands the Bureaucracy

This isn’t a simple assault or DWI case. A Medical Assistance fraud charge is born from a mountain of regulations, billing codes, and administrative rules. I have navigated the complex world of the Department of Human Services and Minnesota’s healthcare statutes. I know how the state builds these cases, where their investigators cut corners, and how to use their own bureaucratic complexity against them. I can speak the language of CPT codes, cost reports, and statistical sampling, allowing me to challenge the very foundation of the state’s case.

Early Intervention Can Change Everything

The best time to fight these charges is before they are even filed. If you’ve been contacted by an auditor or investigator, the clock is already ticking. By retaining me early in the process, I can intervene on your behalf, manage all communications with the state, and begin building a defensive strategy immediately. In some cases, skilled early intervention can demonstrate to the state that their suspicions are unfounded, convincing them to close the investigation without ever filing a criminal charge. This can save your reputation, your career, and your peace of mind.

A Statewide Defense for a Statewide Problem

Whether your practice is in the heart of the Twin Cities or in Greater Minnesota, you need a lawyer who understands the local legal landscape. I have defended clients in courtrooms across the state, from Hennepin County to St. Louis County, Ramsey County to Olmsted County. I know the local prosecutors, judges, and court procedures. This statewide experience allows me to tailor your defense to the specific environment where your case will be heard, giving you a critical home-field advantage.

A Singular Focus on Results That Matter

My goal is to achieve the best possible outcome for you. For some clients, that means a full acquittal at trial. For others, it means negotiating a pre-trial dismissal. For another, it could be a carefully structured plea agreement to a non-fraud offense that saves their professional license. I will not push you into a one-size-fits-all solution. We will work together to define what a “win” looks like in your unique situation, and I will fight tirelessly to achieve it. Your future is on the line, and I will be the determined, persuasive advocate you need to protect it.