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Reporting Fraud and Complaints Policy

Scope

This policy applies to navigators and CACs.

Terms and Definitions

Fraud: An illegal act to obtain something of value through a willful misrepresentation. (i.e. providing false income to obtain benefits)

Waste: Involves taxpayers not receiving reasonable value for money in connection with any government funded activities (i.e. mismanagement, inappropriate actions, inadequate oversight)

Abuse: Involves behavior that is deficient or improper (i.e. misuse of authority for personal financial interests)

Minnesota Statute 13.392 subd. 2: Provides the public with certain protections on the privacy of your information

Policy Details

To ensure navigators and CACs have a process for reporting complaints and fraudulent activity.

Procedures

Our assisters are critical allies in MNsure’s fight against ethical violations like fraud, waste, and abuse. Assisters can report concerns to us by filing a complaint, even if the violations happened in the past.

Reporting can be anonymous. You are not required to provide your name or any other contact information when you file a fraud report or complaint.

A Tennessen Warning is given to any individual who files a complaint. The Warning states:

You are providing information that will be used to determine if any statutes, regulations, or rules related to MNsure have been violated. You are not obligated to provide MNsure with this information. The information you provide may be used in a disciplinary or other action. If you choose NOT to provide the information, MNsure may not be able to fully investigate the complaint you are filing. The information you provide may be shared with employees at MNsure and other state or local agencies as needed, the Legislative Auditor, persons authorized by court order, or law enforcement.

  1. There are two main ways to file a fraud report:
    1. Call the MNsure anonymous complaints telephone line at 1-844-466-7873; or
    2. Send an email to the MNsure Compliance hotline at mnsurecompliancehotline@mnsure.org

      The anonymous complaints telephone line is operated by a third-party vendor and allows callers to file reports without leaving identifying information.

      The MNsure Compliance email is monitored by the MNsure Compliance Department.

  2. Information to include in your complaint:
    1. About you (optional):
      1. Name
      2. Mailing Address
      3. Day and evening telephone numbers (tell us the preferred time to call)
      4. Email address
    2. About the situation:
      1. Explain what you think was inappropriate.
      2. Who was involved? Include names and positions, if you have them.
      3. When (roughly) did the improper action(s) take place?
      4. What law, rule, policy, or other standard do you think was violated?
      5. What witnesses, documents, or other evidence do you have to support this claim? Please attach copies to your email.
      6. Have you filed this allegation with another government office? If so, please tell us what actions that office took, if any.
  3. MNsure reviews all complaints and takes appropriate action. If you have any questions about this reporting process, please contact the CAP staff or the MNsure Compliance Department in the manner described above.
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