Louisiana's health department is sloppy in monitoring billions of dollars in payments to private companies that manage care for 1.5 million of the state's Medicaid patients, according to a new audit.
Legislative Auditor Daryl Purpera's office identified what it considers a lengthy list of shortcomings in the oversight of the five managed care organizations from 2012 through 2017.
Auditors say the Louisiana Department of Health, known as LDH, isn't properly tracking health providers billing the managed care organizations for Medicaid patient services. The report says that lax oversight makes it impossible to know if the Medicaid program is paying for things it shouldn't be.
"Without complete data that accurately identifies the provider who performed the service, who was paid for the service, where the service was provided and the level of services the provider is allowed to perform, LDH cannot effectively monitor the (companies) and decrease the risk of improper payments," auditors wrote in the report.
Health department officials said Tuesday that the audit is misleading.
Michael Boutte, Medicaid deputy director, said the agency has many ways to track provider claims that auditors didn't review.
"It's pretty clear that the auditors aren't saying these are improper payments, and we don't expect any improper payments," Boutte said in an interview. "We absolutely know 100 percent of the time who the providers are submitting claims."
Auditors reviewed data from February 2012 through December 2017, a period that includes the administrations of former Gov. Bobby Jindal and current Gov. John Bel Edwards. Purpera's office looked at the health department's processes for checking the reliability of the Medicaid claims paid to health care providers by the managed care organizations.
The review said auditors found 41 million paid claims totaling $2.4 billion from October 2015 through December 2017 that didn't have valid provider identification numbers. They found more than 194,000 claims totaling $13 million where the provider type and a specialty code associated with it didn't match. They identified $136 million in paid claims where a registry showed that a health provider wasn't enrolled with the managed care organization making the payment. Another $587 million in paid claims involved health providers not linked to a managed care plan.
Boutte said the department has cleaned up data collection and monitoring problems it inherited from the Jindal administration and has worked to improve data quality. He said while there's room for improvement, "we do feel confident with our current tracking system."
For example, Boutte said just because a provider isn't linked to a managed care plan, that doesn't mean the care isn't allowed. Those are out-of-network charges, like private health insurance plans have, he said.
The current managed-care contracts were negotiated by the Jindal administration, though they were tweaked by the Edwards administration in recent contract extensions. The current deals with the managed-care companies run through 2019.