Section 609.467 replaced the former law on August 1, 2026

Before August 1, 2026, medical-assistance fraud was charged under Minnesota Statutes section 609.466. That short statute treated the intentional presentation of a materially false Medical Assistance claim, cost report, or rate application as attempted theft of public funds and used the theft statutes to determine punishment.

2026 Minnesota Laws chapter 127, article 7, sections 3 and 7, repealed section 609.466 and enacted section 609.467. The new law is effective August 1, 2026, and applies to crimes committed on or after that date.

The offense date therefore matters. Conduct completed before August 1 must be evaluated under the former statute and the law then in effect. The State cannot retroactively apply the new 20- or 30-year penalty tiers, new offenses, or expanded restitution rules to earlier completed conduct. A case involving conduct on both sides of the effective date requires a careful chronology and ex post facto analysis.

The new statute is not limited to successful payment. Several clauses expressly include attempting, conspiring, participating, preparing, offering, or tendering. A claim need not necessarily be paid for the State to allege a completed violation under the current text. The charged clause controls.

Section 609.467 also separates criminal wrongdoing from recordkeeping failure. Subdivision 1 contains the felonies. Subdivision 3 creates a gross misdemeanor when a person submits a covered claim, cost report, or rate application and knowingly and intentionally fails to maintain records required by chapters 245A or 256B or the implementing rules.

Because the statute is new, older appellate decisions interpret the repealed section 609.466, not the current eight-clause offense. Those decisions may illuminate historical practice but cannot be quoted as though they define section 609.467.

The current statute defines eight felony theories

1. Fraudulent scheme or artifice. A person acting with intent to defraud commits the offense by executing, participating in, attempting, or conspiring to execute a scheme to obtain Medical Assistance money or credits through false pretenses, representations, promises, or concealment of a material fact.

This clause can reach an overall business model rather than one invoice. The State may allege sham ownership, nonexistent services, recruited recipients, fabricated staffing, concealed related parties, or a coordinated billing system. The prosecution still must prove the accused’s participation, fraudulent method, materiality, and intent.

2. Ineligible claims, cost reports, and rate applications. A person acting with intent to defraud commits the offense by presenting, submitting, tendering, offering, participating in, or attempting or conspiring in the preparation of a claim, cost report, or rate application while knowing or having reason to know that some part is ineligible for payment or reimbursement.

3. Enrollment, provider-agreement, and ownership disclosures. A person acting with intent to defraud commits the offense by knowingly providing false information or intentionally omitting material information in a required enrollment application, provider agreement, or ownership and management disclosure under chapter 245A or 256B or applicable federal law.

4. Operation by a suspended or excluded person. A person violates this clause by owning, operating, managing, or exercising control over an entity receiving Medical Assistance money while knowing or having reason to know that the person is suspended or prohibited from enrollment by state law or agency, or excluded or prohibited under federal law.

5. Permitting an excluded person to control an entity. A person violates this clause by knowingly and intentionally allowing another excluded, suspended, or prohibited person to own, operate, manage, or exercise control over an entity receiving Medical Assistance money while knowing or having reason to know of that status.

6. False or altered service records. The statute prohibits falsely making or altering a record about delivery of Medical Assistance services so the record appears to have been made by another person, under a false name, at another time, with different provisions, or with authority that was never given.

7. PCA and CFSS claims with unmet payment conditions. A person acting with intent to defraud violates this clause by participating in or attempting or conspiring in specified claims while knowing or having reason to know that required authorization, plan, documentation, training, supervision, evaluation, or another program condition was not met.

8. Destruction after a lawful records request. After a lawful request from a state agency or law-enforcement agency, the statute prohibits intentionally destroying, attempting to destroy, or conspiring to destroy medical, health-care, and financial records that chapters 245A or 256B or their rules require the person to maintain.

A complaint should identify the clause or clauses charged. Proof that recordkeeping was poor does not automatically prove a fraudulent scheme. Proof that one claim was ineligible does not automatically prove every claim was false. Each count requires evidence matching its text.

Intent to defraud, knowledge, and “reason to know” are different

Most current theories include a mental-state requirement. Clauses 1, 2, 3, and 7 expressly require intent to defraud. Clauses 2 and 7 also refer to knowing or having reason to know that the payment condition was not met. Clauses 4 and 5 focus on knowledge or reason to know about exclusion or suspension. Clauses 6 and 8 use their own falsification or intentional-destruction language.

Intent to defraud ordinarily concerns a purpose to deceive and obtain an unauthorized financial benefit or cause financial loss. It can be proved through direct statements or circumstantial evidence. Repeated identical entries, concealed ownership, backdating, warnings, personal payments, fabricated signatures, or instructions to staff may support an inference. Honest error, misunderstanding, reliance, or good-faith correction may point the other way.

“Having reason to know” does not make every mistake criminal. The State should identify the facts that allegedly put this defendant on notice. A general provider manual, mass email, unexplained remittance code, or rule change may not prove that a particular owner, clinician, biller, or employee understood a specific defect.

Organizational roles matter. A licensed professional may document care but never submit claims. A biller may transmit coded data supplied by a clinic. An owner may delegate day-to-day compliance. A supervisor may approve time without seeing enrollment disclosures. Criminal liability must be tied to the individual’s acts and required mental state, not assumed from title alone.

Delegation does not create automatic immunity. Evidence that a decision-maker designed the process, ignored repeated warnings, directed alterations, concealed ownership, or benefited from false claims can support liability. The defense should distinguish legitimate division of labor from deliberate blindness or participation.

Materiality is explicit in the scheme and enrollment provisions. The alleged falsehood or omission must matter to payment, eligibility, enrollment, ownership review, or another government decision. A typo or immaterial discrepancy should not be treated like a concealed disqualification.

Claims and records must be examined at the transaction level

Medical Assistance billing moves through several layers: eligibility and enrollment, service authorization, plan of care, delivery, documentation, coding, claim transmission, adjudication, remittance, adjustment, and audit. A defect at one layer does not always establish fraud at another.

A paid claim is not proof that it was proper, but a later denial is not proof of criminal intent. Agencies deny or recoup claims for untimely submissions, missing signatures, coding mistakes, insufficient documentation, eligibility changes, authorization limits, duplicate billing, or medical-necessity disputes. Administrative ineligibility and criminal fraud are not synonymous.

The defense should obtain the native claim data rather than rely only on an auditor’s spreadsheet. Relevant fields include provider identifiers, recipient, date and place of service, procedure and modifier, units, amount billed, amount allowed, status, adjustments, voids, resubmissions, and the user or system that created the entry.

Sampling and extrapolation can become contentious. An audit may review selected claims and estimate a larger overpayment. A criminal loss calculation should be tested for sampling method, universe definition, confidence, duplicate treatment, offsets, partially supported services, and whether the same defect actually affected unreviewed claims.

Clinical and service records require context. Late entries may be permitted if identified properly. Corrections may be legitimate if the audit trail remains intact. Templates can produce repetitive language without proving a nonexistent service. Conversely, a record falsely attributed to another person or time can fall directly within clause 6.

Electronic-health-record audit logs may identify logins, timestamps, edits, signatures, and access. They do not always identify the human user if credentials were shared or sessions remained open. Time zones, automatic saving, batch signing, system migrations, and vendor architecture may need expert explanation.

Subdivision 3 creates a separate gross-misdemeanor offense for knowingly and intentionally failing to maintain required records after submitting covered payment material. It is not enough to show that a file is missing from the investigator’s production. The State must prove the duty, the person’s submission, and the knowing and intentional failure to maintain.

Ownership, management, control, suspension, and exclusion

Clauses 3 through 5 focus heavily on provider identity and control. Medical Assistance enrollment demands disclosure of owners, managers, controlling interests, related parties, and other information. The current crime reaches intentional material omissions in those documents and concealed control by people barred from participation.

Formal paperwork may not tell the whole story. Investigators may examine who formed the company, supplied capital, hired staff, controlled bank accounts, negotiated leases, set policies, communicated with DHS, signed checks, directed billing, and received profits. A nominal owner can be alleged to be a front for an excluded operator.

The State must still prove the charged knowledge. Exclusion notices can be misdirected, limited in scope, appealed, expired, or misunderstood. A person’s name may resemble another’s. A business may receive incomplete compliance information. Official exclusion and enrollment records, notice, dates, and the actual legal effect should be verified.

Clause 4 applies when the accused person is the suspended or prohibited individual operating or controlling the entity. Clause 5 applies to a person who knowingly and intentionally allows someone else with disqualifying status to do so. The two theories require different proof and should not be collapsed.

“Exercises control” is broader than formal ownership but should remain tied to real authority. Advice, friendship, family relationship, occasional help, or employment does not necessarily equal control. Bank authority, decision rights, operational commands, contracts, and financial benefit can be relevant.

Provider enrollment and licensing are not always identical. A person may face limits under a state agency, state law, federal agency, or federal law. The prosecution should identify which suspension, prohibition, or exclusion applied and why it barred the specific conduct at the charged time.

PCA and Community First Services and Supports claims

Clause 7 specifically addresses personal care assistance under section 256B.0659 and Community First Services and Supports under section 256B.85. These programs have detailed rules concerning authorization, service plans, worker eligibility, documentation, training, supervision, evaluations, covered tasks, location, and billing.

A violation requires more than a technical defect. The clause requires intent to defraud and knowledge or reason to know that a payment condition was unmet. A missing document caused by clerical error, late supervision note, misunderstood transition rule, or ambiguous authorization may support recoupment without proving criminal intent.

Common allegations include billing while a recipient was hospitalized or away, overlapping worker hours, impossible daily totals, services by an unqualified worker, unsupported units, forged recipient verification, billing for care not delivered, or supervision and evaluation that did not occur.

Schedules and location evidence need careful interpretation. A worker may provide authorized care during travel or at a location other than home. Hospital admission and discharge times may not cover an entire date. Phone location belongs to a device, not always the person. Payroll time and billing units may measure different things.

Recipient statements can be important but require context. Memory, cognitive limitations, language, family conflict, service definitions, and the passage of time may affect recollection. Interviews should be reviewed in full, including how dates and tasks were presented.

Employers should preserve training files, background checks, qualifications, care plans, worker timesheets, recipient approvals, supervision records, communications, GPS or electronic-visit-verification data, and claim corrections. Recreating missing records after an inquiry can create a falsification allegation; preservation is different from alteration.

Penalties, aggregate loss, restitution, venue, and limitations

Subdivision 2(a) sets a maximum of ten years in prison and a $20,000 fine for a felony under subdivision 1. This tier applies when the State does not prove an aggregate loss over $100,000. A completed payment is not necessarily required for every clause.

Subdivision 2(b) authorizes up to 20 years and a $100,000 fine when the violation causes aggregate loss of more than $100,000 but not more than $1 million. Subdivision 2(c) authorizes up to 30 years and a $1 million fine when aggregate loss exceeds $1 million.

The thresholds make loss calculation a major trial and sentencing issue. The State must prove the applicable tier beyond a reasonable doubt when it increases the statutory maximum. Disputed claims, legitimate services, offsets, reversed payments, duplicate counts, extrapolation, and causation can change the tier dramatically.

The current Minnesota Sentencing Guidelines severity table ranks the $100,000-or-less tier at severity level 2, the $100,001-to-$1-million tier at level 6, and the over-$1-million tier at level 8. The presumptive disposition and duration also depend on criminal history and the guideline rules effective on the offense date.

Subdivision 6 permits restitution for losses from the crime and for certain similar related conduct that was not charged. For related uncharged conduct, the prosecutor must give notice at least five business days before sentencing, the conduct must fall within the limitations period, and the State bears the burden. The defendant may challenge restitution under section 611A.045.

That restitution authority does not make an auditor’s total automatic. The defense can dispute whether costs or losses resulted from the crime, whether other conduct was sufficiently similar and related, whether credits and recovered money were considered, and whether notice was adequate.

Subdivision 4 makes violations of subdivisions 1 and 3 continuing offenses for limitations purposes. If any part of the continuing scheme, conspiracy, or conduct occurred within the applicable period, the statute states that acts during the course may fall within it. The prosecution still must identify the charged continuing conduct and prove the defendant’s involvement.

Venue is also broad. A case may be prosecuted in a county where any part occurred or where the entity receiving the claim, cost report, or rate application is located. Venue objections should be evaluated from claim routing, agency location, business acts, and the specific theory.

Kickbacks and illegal remuneration are charged separately

Payments for referrals or program business may be prosecuted under Minn. Stat. § 609.542 (2026), Minnesota’s illegal-remuneration statute. It covers intentionally soliciting or receiving, and intentionally offering or providing, money, discounts, credits, waivers, rebates, goods, services, employment, or another thing of value in return for or to induce specified referrals, purchases, orders, recommendations, applications, or receipt of covered services.

Legitimate compensation is not automatically a kickback. The statute contains exceptions tied to federal statutory and regulatory safe harbors and specified program arrangements. Employment, discounts, waivers, leases, marketing, referral relationships, and ownership distributions require fact-specific review.

The remuneration statute uses the value of what was offered, paid, solicited, or received to set penalties. It permits aggregation within six months. A provider may face both remuneration and false-claim allegations if claims resulted from the allegedly unlawful arrangement.

Section 609.467 does not itself use the word “kickback.” A page that treats every remuneration issue as a subsection of medical-assistance fraud would be inaccurate. Prosecutors may charge the statutes together, but the elements and penalty calculations remain distinct.

Federal anti-kickback, exclusion, and false-claims laws may also apply when federal health-care money is involved. State and federal investigators can share evidence. A defense should determine which sovereign is investigating, whether parallel subpoenas or warrants exist, and whether resolving one matter affects another.

How Medical Assistance fraud investigations develop

An inquiry may begin with data analytics, a recipient complaint, employee report, competitor, managed-care organization, licensing review, payment audit, exclusion match, or referral from another agency. Investigators may compare claims with hospitalization, school, travel, payroll, death, incarceration, or other government data.

The first contact may look administrative. A records request, corrective-action letter, payment hold, site visit, or provider interview can later support a criminal case. Organizations should route requests through responsible counsel, preserve information, meet lawful deadlines, and avoid speculative explanations before the records are understood.

Minn. Stat. § 256B.064 (2026) authorizes significant provider sanctions and payment actions in specified circumstances. Administrative withholding, suspension, termination, or recovery can threaten a business before criminal charges are resolved. Those actions may have separate notice and appeal deadlines.

Search warrants may target offices, homes, phones, email, cloud storage, bank accounts, payroll, and electronic-health-record systems. The defense should review probable cause, particularity, execution, privilege screening, seized data, and whether investigators searched outside authorized limits.

Employee interviews can create conflicting accounts about who made decisions. Billing staff may understand claim mechanics but not clinical delivery. Clinicians may understand care but not eligibility. Owners may rely on managers. Investigators may present each witness with selected records. The complete interview recordings and role documents matter.

Financial analysis should follow money without assuming that revenue proves fraud. Payroll, taxes, rent, vendor costs, owner draws, intercompany transfers, loans, and repayments must be categorized accurately. Commingling or poor bookkeeping may be suspicious but is not a substitute for proving the charged act and intent.

Once a lawful request for required records is received, destruction can become an independent felony theory under clause 8. Routine deletion policies, litigation holds, backup systems, device replacement, and employee departures should be documented immediately. Deliberate destruction and ordinary data lifecycle are not the same.

Defense analysis in a Medical Assistance fraud case

No intent to defraud. Complex rules, training deficiencies, software mapping, payer instructions, delegated billing, inconsistent agency guidance, or good-faith interpretation can produce ineligible claims without criminal intent. Prompt corrections and transparent communication may support good faith.

The claim was eligible. The State may misread authorization dates, service definitions, modifiers, place-of-service rules, units, travel, remote care, recipient eligibility, or documentation. Program and clinical experts may be necessary to show why payment was proper.

The accused did not know and had no reason to know. Organizational responsibility must be individualized. Job descriptions, access permissions, training, communications, approval chains, and system logs can show what information a person actually had.

The statement was not false or material. An ambiguity, estimate, clerical mistake, or immaterial omission does not automatically satisfy a false-statement theory. The government’s own forms and guidance may show that the requested disclosure was unclear.

No prohibited ownership or control existed. The defense can challenge whether the person exercised real operational control, whether an exclusion applied, whether notice occurred, and whether the entity was receiving the covered funds at the charged time.

Records were preserved or not legally required. For clauses 6 and 8 and subdivision 3, retention rules, custody, alteration, authority, request validity, backup history, and destruction intent matter. A missing record is not necessarily a knowingly destroyed record.

The loss calculation is overstated. Legitimate services, partial compliance, offsets, recoupments, unpaid claims, duplicate entries, sampling errors, and lack of causation can reduce loss below a statutory or guideline threshold.

Reliance on qualified professionals supports good faith. Reliance is strongest when facts were disclosed fully and advice was followed. It is not a universal defense, but attorney, accountant, consultant, compliance, or agency guidance can negate fraudulent intent in an appropriate case.

The search, seizure, or statement was unlawful. Overbroad warrants, compelled testimonial production, custodial interrogation, privilege intrusion, and searches outside authorized scope can support suppression or other remedies.

The new statute does not apply retroactively. Conduct before August 1, 2026, must be evaluated under the former law. The prosecution cannot use later-created offenses or higher penalties merely because an audit or charging decision occurred after that date.

Minnesota caselaw and the change from the former statute

No Minnesota precedential appellate decision yet interprets section 609.467, which took effect August 1, 2026. Older opinions concern the repealed statute and should be used with that limitation stated clearly.

In State v. Bakare, No. A17-0451, slip op. at 6–11 (Minn. Ct. App. Mar. 12, 2018) (nonprecedential), the Court of Appeals addressed former section 609.466 and its incorporation of attempted-theft penalties. The opinion explained that under the old law “medical-assistance fraud is itself an ‘attempt’ crime.”

Bakare affirmed treatment of those former-law charges as felonies and discussed using jury findings on aggregate value. It is nonprecedential, and the legislature has since replaced the statute with direct penalty tiers. It should not be cited for the proposition that current section 609.467 merely incorporates theft penalties; it does not.

The current statute expressly defines attempts and conspiracies within several clauses, sets its own maximums, defines continuing offenses and venue, and authorizes expanded restitution. Future appellate cases will determine how its new phrases, mental states, aggregation, and related-conduct restitution operate.

Until then, courts will apply established Minnesota principles governing statutory construction, intent, knowledge, circumstantial evidence, loss findings, search and seizure, restitution, and sentencing. The defense should preserve objections rather than assume old billing-fraud practice resolves a new statutory question.

Administrative, civil, licensing, and business consequences

A criminal case may proceed alongside payment suspension, recoupment, provider termination, license action, exclusion, tax review, civil false-claims litigation, and contract disputes. Each uses different procedures and may define overpayment, abuse, and fraud differently.

Minnesota’s civil False Claims Act, Minn. Stat. § 15C.02 (2026), can create civil liability for specified false or fraudulent claims and related conduct. Civil exposure can exceed the criminal loss figure because remedies, proof standards, and covered conduct differ.

Licensing bodies may act on conduct, findings, or convictions affecting health-care, social-service, or facility licenses. A provider agreement may permit withholding or termination without waiting for conviction. Managed-care contracts may have separate audit and indemnity provisions.

Businesses should consider continuity of care, payroll, record access, insurance notice, lender covenants, employee communication, recipient privacy, and preservation. An abrupt shutdown or mass deletion can harm recipients and create additional evidence problems.

Individuals may face employment loss, professional discipline, immigration consequences, restitution, forfeiture, tax liability, and inability to participate in public programs. Noncitizens and licensed professionals should receive specialized advice before any plea.

A global resolution should identify which forum is bound, what payments remain disputed, whether exclusion or licensing action follows, how restitution and recoupment interact, and what factual admissions can be used elsewhere. A criminal plea rarely resolves every administrative and civil issue automatically.

Frequently asked questions about Minnesota Medical Assistance fraud

1. What statute now governs Medical Assistance fraud?

For conduct on or after August 1, 2026, Minnesota Statutes section 609.467 governs. Former section 609.466 was repealed. Conduct before the effective date must be analyzed under the prior statute and the law then in force.

2. Is every overpayment criminal fraud?

No. An overpayment may result from mistake, ambiguous rules, missing documentation, changed eligibility, coding, medical-necessity disagreement, or another administrative issue. The State must prove the act and mental state in the charged clause beyond a reasonable doubt.

3. Can a person be charged when a claim was never paid?

Potentially yes. Several clauses cover attempts, conspiracies, preparation, offers, or tendering, and the scheme clause concerns obtaining money or credits. Whether payment or loss must be proved depends on the charged theory and penalty tier.

4. What does “intent to defraud” mean?

It generally concerns a purpose to deceive to obtain an unauthorized benefit or cause financial loss. It may be inferred from circumstances, but error or noncompliance alone does not establish it. The defendant’s role, knowledge, warnings, corrections, and communications matter.

5. Can an owner be charged for an employee’s billing?

Ownership alone does not prove personal criminal liability. The State must connect the owner to participation, intent, knowledge, control, permission, or another charged basis. Evidence that an owner directed, concealed, or knowingly benefited from false billing can be important.

6. Can a biller be charged for information supplied by clinicians?

Yes, if the biller’s conduct and mental state satisfy a clause, but transmission alone is not automatic fraud. Access, instructions, training, claim fields, warnings, and whether the biller knew or had reason to know of ineligibility should be examined.

7. What is the separate recordkeeping offense?

Subdivision 3 makes it a gross misdemeanor to submit specified payment material and knowingly and intentionally fail to maintain medical, health-care, and financial records required by chapter 245A or 256B or their rules. It is distinct from intentional destruction after a lawful request, which is a felony theory.

8. What are the maximum penalties?

The ordinary felony maximum is ten years and $20,000. Aggregate loss over $100,000 through $1 million carries up to 20 years and $100,000. Loss over $1 million carries up to 30 years and $1 million. The gross-misdemeanor records offense has separate misdemeanor penalties.

9. How does the State calculate aggregate loss?

Investigators may total challenged payments across the alleged violation. The defense can contest claim eligibility, sampling, extrapolation, duplicate entries, offsets, reversed payments, legitimate services, causation, and whether conduct belongs to the same charged scheme.

10. Can restitution include uncharged claims?

Section 609.467 allows restitution for certain similar related conduct that was not charged if it occurred within the limitations period and the prosecutor gives at least five business days’ notice before sentencing. The State bears the burden, and the defendant may challenge the request.

11. Is a kickback charged under section 609.467?

Not necessarily. Minnesota has a separate illegal-remuneration statute, section 609.542, covering specified offers, payments, receipts, discounts, employment, and other value connected to referrals or covered business. Fraud and remuneration counts may be charged together.

12. Can DHS stop payments before a criminal conviction?

Yes, depending on statutory and program authority. Administrative payment holds, suspension, termination, recoupment, and enrollment action can occur separately from criminal court. Notice and appeal deadlines may be short.

13. Should records be corrected after an audit notice?

Do not backdate, overwrite, or conceal an original entry. Legitimate late entries or corrections may be possible when clearly identified and permitted, but counsel and compliance professionals should guide the process. Preserve audit trails and the original data.

14. Should I speak with an investigator?

Obtain legal advice first. A provider interview can become evidence in criminal, administrative, licensing, and civil proceedings. Investigators may know records you have not reviewed. Counsel can clarify the request and advise whether any interview is appropriate.

15. What should be preserved?

Preserve native claim files, remittances, adjustments, electronic-health-record audit logs, service notes, authorizations, care plans, schedules, payroll, training, supervision, enrollment and ownership records, bank records, contracts, emails, texts, audit correspondence, policies, backups, and retention logs.

Current-law analysis starts with the charged clause and offense date

Medical Assistance fraud is now a standalone, multi-part crime with severe direct penalties. The current statute does not allow investigators to turn every recoupment into fraud. It requires proof of the charged act and mental state, and the State must establish any loss tier that increases the maximum punishment.

Effective defense work combines criminal law with program rules, claim data, clinical documentation, ownership records, electronic audit trails, administrative deadlines, and a defensible loss calculation. It must also keep the former and current statutes separate.

This guide describes Minnesota law in 2026 and is general information, not legal advice. A prompt, coordinated response can preserve records, prevent destructive mistakes, and protect rights across criminal, administrative, licensing, and civil proceedings.