Medicaid Fraud Task Force Recommends Changes to State's Medicaid Program in Interim Report
Five areas formed the focus of discussions held by members of the Legislature’s Medicaid fraud task force last fall, according to an interim report issued by the panel. The areas were:
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 Task Force on Coordination of Medicaid Fraud Detection & Prevention Initiatives was created by Act 420 of the 2017 Regular Legislative Session. Members of the task force were charged with studying and evaluating the State’s Medicaid fraud detection and prevention efforts and developing recommendations to help improve those processes.
Among the changes the task force recommended were using tax data to help determine eligibility, analyzing the costs and benefits of reducing LDH’s reasonable compatibility standard, and developing a standardized process for reporting the results of eligibility fraud reviews.
In addition, the task force recommended better coordination of data-mining efforts and continued use of the Healthcare Fraud Prevention Partnership, as well as close monitoring of Managed Care Organization contracts and determining whether the State should set up an electronic visit verification system for mental health rehabilitation services.
The report also outlined several areas the task force still needs to address, including development of a recipient fraud unit, LDH’s current processes for verifying eligibility, amendment of the Medical Assistance Program Integrity Law, the Medicaid rate-setting process versus the Medical Loss Ratio, non-emergency use of emergency rooms, the inclusion of long-term care in managed care, and restructuring the pharmacy program.
The report and minutes of the task force’s fall 2017 meetings can be found at www.lla.la.gov/PublicReports.nsf/4C858DCBA6E2F5D18625821F00667334/$FILE/00017514.pdf.
For more information contact:
Legislative Auditor
225.339.3800