Audit of Medicaid Service Provider Finds Improper Billings, Ineligible Workers, Documentation Problems

An investigative audit of a St. Mary Parish Medicaid service provider found inaccurate and/or inadequate documentation of services, reimbursements for ineligible workers, and billings for services that either were not provided or were not properly authorized.

Auditors who examined timesheet and service log records for JABA Enterprises, LLC found that, between July 2012 and September 2016, the company billed the Louisiana Medicaid Program $11,090 for 768 hours of personal care services involving eight employees that likely were not provided. Independent records, including timesheets from these employees’ other employers, incarceration records, drivers’ license photos, and employee statements, indicated the eight were not working for JABA during the hours that were billed.

In addition, auditors found several instances in which it appeared that JABA employees providing Now Opportunities Waiver (NOW) services lived in the same household as the recipient. According to the Louisiana Medicaid Program Provider Manual, NOW services may not be provided by a member of the recipient’s family unless that family member does not live in the same residence and is not the legally responsible relative.

Auditors discovered as well that between January 2012 and June 2016, JABA submitted claims to the Medicaid program for services totaling $1,325,807 without prior authorization and approval, which resulted in the claims being denied by the Louisiana Department of Health (LDH). Documentation for NOW services and Long-Term Personal Care Services also was inadequate and/or inaccurate in several cases.

In addition, records obtained from the Louisiana Secretary of State and the Louisiana Workforce Commission indicated that JABA was not in good standing with the agencies because the company failed to file required periodic reports and/or pay amounts owed. State law and rules for Louisiana Medicaid providers require them to be in good standing with state agencies to do business with the State. By failing to maintain its good standing, JABA may be in violation of its Medicaid provider agreements with LDH.