Medicaid Fraud Task Force Cites Changes in Recipient Eligibility Processes, Goals for 2019 in Latest Report
The Louisiana Department of Health (LDH) has taken major steps to implement the recommendations of a legislatively created Medicaid fraud task force, according to the latest report issued by the panel.
The Task Force on Coordination of Medicaid Fraud & Prevention Initiatives was created by Act 420 of the 2017 Regular Legislative Session. Task force members were charged with studying and evaluating the state’s Medicaid fraud detection and prevention efforts and developing recommendations to help improve those processes.
Today’s report reiterates the task force’s recommendations and details how LDH has adjusted its policies and procedures in response.
In addition, the report outlines the task force’s goals for 2019. Those goals fall under the same five focus areas the task force followed in 2018:
1. The need to strengthen Medicaid eligibility determinations
2. The need to better coordinate fraud, waste, and abuse efforts
3. The need to strengthen oversight and tighten controls in the managed care program
4. The need to strengthen the Louisiana Department of Health’s program integrity function related to behavioral health
5. The need to strengthen controls within the Medicaid pharmacy program
The 2019 goals include reviews of the new Medicaid eligibility system (LaMeds); the Louisiana Department of Revenue’s analysis of tax data for a sample of recipients; the impact of eligibility business process changes on LDH; and the managed care organizations’ process for identifying ineligible recipients and notifying LDH, as well as research into the use of recipient verification processes before Medicaid benefits are activated.
In addition, the task force plans to review the number of potential fraud cases that are identified and their outcomes; the reliability of data related to recipient visits to health care providers; LDH’s data integrity activities; and the performance of the dental managed care organization.
Task force members also want to review how LDH is ensuring the managed care organizations’ program integrity efforts are adequate; LDH’s oversight of the mental health rehabilitation program; and commercial market approaches to identifying fraud, waste, and abuse that might be applicable to the Medicaid program.
The report and minutes of the task force’s 2018 meetings can be found at www.lla.la.gov/PublicReports.nsf/DF615498414217F886258369006586BA/$FILE/0001B23E.pdf.
For more information contact:
Legislative Auditor
225.339.3800