LDH Able to Recoup about $25 Million in Medicaid Fees for Incarcerated Individuals; Another $2.1 Million Not Recovered

Auditors examining how the Louisiana Department of Health (LDH) identifies incarcerated Medicaid recipients and recovers per member per month fees paid to the managed care organizations (MCOs) overseeing the program found the Department has improved its process.

Between January 2014 and March 2018, the Department recovered approximately $25 million in per member per month fees. However, auditors identified an additional $2.1 million in per member per month fees paid on behalf of 1,010 incarcerated Medicaid recipients that LDH did not recover between January 2014 and June 2017.

This report is a follow-up to one LLA released in July 2014. In that report, auditors found that LDH paid approximately $2.7 million in per member per month fees for 2,644 incarcerated individuals enrolled in MCOs between February 2012 and December 2013.

LDH’s process for identifying incarcerated Medicaid recipients involves matching individuals to data sent from the Department of Corrections (DOC) on a nightly basis. Although LDH was able to recover $25,470,307 through this process, it did not recover $2,130,313 because in 70 instances DOC did not provide the names of the individuals in question, and in 940 instances LDH received the names but rejected them because of partial data matches or conflicting dates of incarceration.

In some cases, LDH found individuals were not incarcerated, but did not tell DOC so it could correct its data. For example, auditors found one instance in which DOC data incorrectly identified a Medicaid recipient as incarcerated, which led LDH to remove the recipient from her managed care plan. The individual called LDH multiple times to correct the error and a caseworker tried to reopen the woman’s Medicaid file to allow her to receive needed medication, but the process took 17 days.

As of January 2018, the DOC website still showed the individual as incarcerated. According to LDH and DOC staff, LDH was supposed to develop a website to share this type of information, but that had not happened during the time of the audit.