Today, Gov. John Bel Edwards announced that the Trump Administration’s Office of Inspector General Department of Health and Human Services audit has found that Louisiana’s Medicaid program has complied with the federal fraud reporting requirements, has the proper procedures in place to report fraud and is not in need of any recommendations for improvement. Louisiana is one of only four states to pass this audit since 2014.
“This is exciting news and is the direct result of diligent oversight by the Department of Health to make certain that precious taxpayer dollars are not misused and abused,” said Gov. Edwards. “I applaud Dr. Rebekah Gee and her team for their dedication in going after those few healthcare providers who try to take advantage of this program. Our state is operating under very difficult financial times, and Medicaid fraud is often targeted as a problem area. This news should help allay the fears of those who often criticize the state’s efforts. The message is clear - when it comes to getting tough on Medicaid fraud, Louisiana is among an elite group of states leading the way by doing the right thing.”
Specifically, the audit reviewed Louisiana Medicaid’s financial and management anti-fraud policies and practices. They ensure that credible cases of Medicaid fraud are detected, that actions are taken to stop payments to suspicious providers and that referrals are made to the Attorney General’s Office for investigation and prosecution, when applicable.
In its review, the Office of the Inspector General reviewed 225 cases of providers who were suspected of fraud and abuse. In 100 percent of the cases, the Louisiana Department of Health (LDH) was found to have made the proper decision regarding referring a provider suspected of fraud to the Louisiana Attorney General.
“As stewards of limited taxpayer dollars, preventing Medicaid fraud is a top priority of the department,” said LDH Secretary Dr. Gee. “As demonstrated by this successful audit, we are ruthless in our efforts to stop criminals who are intent on defrauding the Medicaid program. We have improved the systems that detect fraud, and we refer all alleged fraud cases to the Attorney General.”
Within LDH and its partner managed care organizations, there are multiple systems in place to detect and prevent fraud. These include state-of-the-art software that uses pattern matching algorithms and predictive analytics to look for duplicate charges and other potentially fraudulent billing practices.
Also, each managed care organization has its own program integrity units that work with the department to coordinate data and information that is critical to fraud prevention.