BATON ROUGE (AP) — Louisiana's health department should be pressing harder to correct problems found by auditors who say the agency does a poor job overseeing billions in Medicaid payments and can't be sure the money was spent properly, a state Senate leader said.
Senate Health and Welfare Chairman Fred Mills, a St. Martin Parish Republican, was dissatisfied with the department response to the audit. He wrote to Health Secretary Rebekah Gee seeking more details about how her agency will correct the identified shortcomings.
Legislative Auditor Daryl Purpera's office reviewed payments from 2012 through 2017 to the five private companies that manage care for 1.5 million of the state's Medicaid patients. The report says the health department isn't properly tracking health providers billing the managed care organizations for Medicaid patient services. Auditors say sloppy oversight makes it impossible to know if Medicaid is paying for things it shouldn't be.
"With billions of taxpayer dollars going to the (companies), they have to be better managed and more highly scrutinized to ensure that we are most appropriately using the funding allocated for the health care of our citizens," Mills wrote in the letter sent Tuesday.
Several GOP lawmakers are pushing for tightened scrutiny of a Medicaid program that tops $12 billion in annual spending and accounts for about 40 percent of the state operating budget.
When the audit was released, health department leaders suggested it was misleading, saying the agency has more ways to track provider claims and payment accuracy that auditors didn't review. They said they know the providers who are submitting claims and they were confident the payments were proper.
In a three-page letter sent Thursday to Mills, Gee said her agency is working on system upgrades that will improve provider tracking and has increased penalties for managed care companies that don't have accurate provider information. She said a $50,000 penalty per company already has been assessed for inaccuracies.
"Most importantly, I want to emphasize that this audit did not conclude that any reviewed claims indicated improper payments," Gee wrote.
She said the department had "outdated processes and systems" in place when it moved most of the Medicaid program to a managed-care system under former Gov. Bobby Jindal's administration in 2012. She said Gov. John Bel Edwards' administration has "taken substantial steps to improve our data and oversight."
Purpera's office tallied $3 billion in paid claims that auditors said didn't have valid provider identification numbers, that had improper coding or that involved health providers not enrolled with the managed care organization or linked to a managed care plan.
Purpera said in an interview that Medicaid "is being run kind of willy-nilly, loosey-goosey" without the tightened controls recommended by auditors.
"If the department won't regulate its (managed care organizations), if it won't hold their feet to the fire, they can't really sit back and say there's no improper payments," he said. "There's none we know of, but that's a big difference."
Mills said that if the payments were improper they could skew the monthly rate Louisiana's Medicaid program pays to the private companies for each Medicaid patient.
Gee said that if a provider isn't known to her department, a claim isn't paid.
"We agree that it is critical to ensure that the state is aware of which providers are rendering services," she wrote.