Louisiana Legislative Auditor
Daryl G. Purpera, CPA, CFE

April 3, 2017

Department of Health Paid Out about $1.4 Million in Erroneous Duplicate Medicaid Claims Payments

The Louisiana Department of Health (LDH) made approximately $2.8 million in duplicate Medicaid claims payments between January 2011 and October 2016, the Legislative Auditor said in a report released today. Erroneous payments probably make up about half of that amount, or $1.4 million, auditors said in the report.

After identifying 1,624 unique Social Security numbers linked to 3,255 original Medicaid IDs, auditors discovered payments made under two or more different Medicaid IDs for the same service provided during the same time period for the same individual, either through the fee-for-service program or the managed care plans.

Every Louisiana Medicaid recipient is assigned an original identification number (Medicaid ID) that is used to pay claims under the state’s fee-for-service system or to pay the monthly member premiums to the managed care plans that provide Medicaid services. LDH officials said multiple IDs for individual recipients are necessary in certain foster care and/or adoption situations and in witness protection cases. However, assigning multiple IDs to a single recipient makes it difficult for the department to monitor the complete histories of Medicaid recipients.

LDH became aware of the duplicate managed care premium payments for recipients with multiple IDs as a result of other audit work conducted by the Louisiana Legislative Auditor. At that time, LDH developed a process for identifying duplicate payments made to the same managed care health plans and was able to recover about $1.3 million, which is not included in the $2.8 million in duplicate payments reported in this report by the auditor.

Auditors found LDH does not have an adequate process in place to ensure that claims are only paid once for Medicaid recipients with multiple Medicaid IDs. In addition, the department does not have a way to identify and recoup duplicate payments across different managed care health plans or from fee-for-service providers.

For more information contact:

Legislative Auditor
225.339.3800



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Office of the Louisiana Legislative Auditor | www.LLA.La.gov