As federal and state regulators intensify scrutiny of Medicaid in Minnesota, providers and payers are caught in a high stakes battle over how—and whether—services will be paid. This session will examine the evolving relationship between DHS and CMS and the extent to which increased federal oversight (and tightened purse-strings) are shaping state level enforcement actions, including program integrity initiatives targeting fraud. We will review recent provider challenges to license freezes and payment withholds and take a closer look at CMS’s authority to audit managed care organizations through its Unified Program Integrity Contractors (UPICs). We will also discuss broader trends in the fraud enforcement landscape and offer practical guidance for payers and providers on assessing current risks and adjusting compliance strategies in response to heightened federal and state expectations.