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Director's Corner
Jeff Anderson, M.Ed.
June 12, 2026

Medicaid oversight should be a shield, not a barrier. It’s time to build a system that works.

Recent fraud cases in Minnesota, first in meal programs and childcare, now in disability services, have exposed serious weaknesses in how Medicaid-funded programs are monitored. My concern on this topic is twofold: taxpayers deserve accountability, and people who rely on home and community-based services in North Dakota should not be harmed by poorly designed federal responses. Too often, solutions crafted in distant committee rooms become a patchwork of requirements that create more confusion than protection. Like the old saying- a camel is a horse designed by committee.

The predictable response has been to add high salaried federal administrators, extra positions in Bismarck, more forms, reports, and more paperwork. State program managers are now so tied to their desks that they have little time for in-person monitoring. Poorly thought-out policies exist that restrict staff from using personal vehicles to make community visits, forcing them to use limited car-pool fleets that require even more paperwork to access. The left hand fights the right, and the result makes getting eyes on services difficult to perform. Ultimately creating an environment reliant upon paperwork, reports, and forms and less focused on outcomes and quality. This approach prioritizes documentation over common sense and makes fraud harder to detect.

Meanwhile, administrative burdens fall on every provider, including those doing everything right. Fraudsters, however, navigate the system with ease: fabricated documentation, nonexistent offices passing compliance checks, phantom meals, and millions billed for services never delivered. States have spent heavily on electronic verification systems that are easily defeated by those people intent on cheating. Honest providers, on the other hand, are overwhelmed by paperwork that pulls experienced staff away from direct care and worsens workforce shortages.

We need a different approach. Real oversight is targeted, community-based, and centered on the people receiving services. It verifies that services were actually delivered, not just documented. States should invest in trained field investigators and receive meaningful incentives to uncover fraud. Oversight resources should be directed where they matter most.

One essential change that must occur is reducing caseloads and increasing salaries for state program managers. These roles were meant to improve care, but excessive caseloads and documentation demands have turned them into paperwork-processing positions. Instead of working alongside providers or verifying services in person, staff spend their days at their computer, or matching documentation to payments.

Fraud harms everyone, but it harms people with disabilities most of all when services go undelivered or quality declines. We must shift from paperwork-based oversight to people-centered oversight; oversight that protects vulnerable individuals rather than burying their providers in bureaucracy.

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