Louisiana Collects $250K In Fines From Medicaid Managers


BATON ROUGE, La. (AP) — The private companies that manage care for most of Louisiana's Medicaid patients recently paid $250,000 in fines for inaccurate record-keeping, the state health department said Monday, on the eve of a legislative hearing digging into agency oversight of the companies.

The companies had incorrect records for health providers enrolled with each managed-care plan, the health department said, including inaccuracies in online data used by Medicaid patients to search for providers, make appointments and determine if the doctor is taking new patients.

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Error rates topped 10 percent, which triggered the fine under terms of the companies' contracts with the state. The five companies, which oversee care for 1.5 million Medicaid patients, paid a $50,000 fine each to the state by a July deadline, according to the health department.

"As our agency works to ensure the financial integrity of our Medicaid program, we are aggressively looking to our private partners to ensure their members not only get the right care at the right time but that they have the proper administrative oversight of the program," Health Secretary Rebekah Gee said in a statement.

The department's announcement came a day ahead of a state Senate Health and Welfare Committee hearing to review a June audit by Legislative Auditor Daryl Purpera's office that was sharply critical of supervision of the managed-care companies.

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Purpera's office reviewed payments from 2012 through 2017 to the managed-care companies and determined the health department isn't properly tracking health providers billing companies for Medicaid patient services. The audit tallied $3 billion in paid claims that auditors said didn't have valid provider identification numbers, had improper coding or involved health providers not enrolled with the managed-care organization or linked to a managed-care plan.

Auditors say sloppy oversight makes it impossible to know if the $12 billion Medicaid program is paying for things it shouldn't be.

When the audit was released, health department leaders suggested it was misleading, saying the agency has more ways to track provider claims and payment accuracy that auditors didn't review. They said they were confident the payments were proper.

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Gee has said her agency is working on system upgrades to improve provider tracking. On Monday, she said further fines can be levied on managed-care companies that don't maintain accurate provider information.

"Failure to meet these minimum standards will result in continued monetary penalties," she said.

– by Melinda Deslatte, AP reporter

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