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Audit doesn't show fraud in Louisiana Medicaid
from The AP
August 8, 2018 - ListenUpYall.com

BATON ROUGE, La. (AP) — Democratic state senators Tuesday downplayed a legislative audit that criticized Louisiana's health department as sloppy in monitoring billions of dollars sent to private companies that manage Medicaid patient care.

The audit identified problems that need to be corrected, but doesn't indicate rampant fraud and abuse in Medicaid payments the managed-care companies make to doctors and health providers, Democratic members of the Senate Health and Welfare Committee said during a hearing about the audit.

Sen. Jay Luneau, an Alexandria Democrat, said the audit "was framed in a way that made it seem worse than it is."

After releasing the audit, Legislative Auditor Daryl Purpera told The Associated Press that Medicaid "is being run kind of willy-nilly, loosey-goosey" without tightened controls. That provoked irritation from some lawmakers, because several high-profile Republicans including U.S. Sen. John Kennedy and Attorney General Jeff Landry used the comments to attack the health department overseen by Democratic Gov. John Bel Edwards' administration.

Purpera was out of town and didn't attend Tuesday's hearing. One of his top deputies, Nicole Edmonson, suggested media coverage misrepresented the audit and its findings, even though Purpera made the critical comments himself about poor oversight of Medicaid in interviews and on a conservative radio talk show.

Purpera's office reviewed payments from 2012 through 2017 to the managed-care companies and determined the health department isn't properly tracking health providers billing companies for Medicaid patient services.

The audit tallied $3 billion in paid claims that auditors said didn't have valid provider identification numbers, had improper coding or involved health providers not enrolled with the managed-care organization or linked to a managed-care plan.

Wes Gooch, with the legislative auditor's office, said the review didn't dig into individual claims to determine if there was any specific improper spending. But Purpera has said that sloppy oversight makes it impossible to know if the $12 billion Medicaid program is paying for things it shouldn't be.

"The purpose of this report and the other (prior Medicaid) reports we've put out is to find weaknesses in the program," Edmonson said.

Sen. Norby Chabert, a Houma Republican, said he worried the audit involved millions of claims that the auditor said was missing data to back them up.

"The incident rates are concerning to me more than anything," Chabert said. "We find ourselves in a place that could be ripe for fraud."

Luneau said the implications of the audit appeared to be exaggerated.

"The findings aren't good. We all know that," he said. But he added: "Maybe it's not so bad."

Sen. Gerald Boudreaux, a Lafayette Democrat, agreed: "Nothing that you have presented today has identified fraud."

When the audit was released, health department leaders said the agency has more ways to track provider claims and payment accuracy that auditors didn't review. They said they were confident the payments were proper.

Health officials made similar comments Tuesday. But Health Secretary Rebekah Gee also said her agency is working on system upgrades to improve provider tracking. On Monday, her department announced that the managed-care organizations recently paid $250,000 in fines for inaccurate record-keeping of the type outlined by the legislative auditor's office.

"For a variety of reasons, Medicaid is politicized. These are important findings. We all want to address them, and we want to fix them," Gee said.



 
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