A Louisiana audit that suggested there could be wide-spread Medicaid misspending has prompted a probe on the federal level.
U.S. Sen. Ron Johnson of Wisconsin and Rep. Jim Jordan of Ohio penned a letter Thursday to Centers for Medicare and Medicaid Services head Seema Verma, citing a report from Louisiana Legislative Auditor Daryl Purpera as need for more information about whether there is a national Medicaid spending problem.
“If these improper payments are occurring in one state, it is logical to assume overpayments are occurring in other states,” the Republican congressmen wrote in the letter. “We respectfully request information about what the Centers for Medicare and Medicaid Services plans to do to determine where overpayments are being made, steps CMS will take to recover overpayments, and controls CMS will put in place to ensure federal Medicaid dollars are only paid to those who qualify.”
The Louisiana Legislative Auditor’s Office released its findings in November of an audit that found the Louisiana Department of Health may have spent an additional $85 million over 20 months on providing health care coverage for people who didn’t qualify for the Medicaid program – largely because of the self-reporting standards for employment under the state’s previous eligibility system and worker errors. Medicaid is mostly federally-funded in Louisiana, but the state administers the program.
"Without a sufficient process to determine recipient eligibility, LDH cannot ensure that Medicaid dollars are spent appropriately," the auditor’s office concluded in its overview, which was presented to legislators shortly after its release.
LDH officials have noted that its release came just days before the health department announced its new modernized Medicaid eligibility system was up and running, and the audit didn't reflect the upgrades that have been made.
Louisiana now has one of the nation's most modern Medicaid enrollment systems — an undertaking that leaders say will help address concerns ove…
Still, the audit has been used in Louisiana to highlight the potential for waste in the program.
Johnson and Jordan’s letter marks its first big leap onto the national stage, and they are seeking information about whether other states are potentially relying on incorrect data or have out-of-date eligibility systems.
Johnson is chairman of the Senate Homeland Security and Governmental Affairs Committee, and Jordan is the ranking Republican member of the House Committee on Oversight and Reform.
In the two years since Louisiana expanded its Medicaid health care program, more than 400 women enrolled have been diagnosed with breast cance…
Both committees hold authority to monitor government spending.
Purpera, who is the president-elect of the National Association of State Auditors, Comptrollers and Treasurers, said he’s had multiple conversations with CMS and auditors in other states about the need to monitor Medicaid spending.
“All of us are very interested in Medicaid and trying to do our jobs to ensure that the program’s run in accordance with the rules and regulations that are there,” he said.
He has recently rolled out audits on several facets of Medicaid spending, he said, because the program makes up 41 percent of the Louisiana budget and previously wasn’t subjected to rigorous oversight. The state has implemented several of his recommendations, including tightening an eligibility buffer and more frequent wage checks.
“I think we’re moving in the right direction,” he said.
Gov. John Bel Edwards, a Democrat, expanded Medicaid in July 2016 under an optional provision of the federal Affordable Care Act. Since then, more than 481,000 people, mostly the working poor, have been added to the state's Medicaid rolls.
The expansion applies to adults whose household income falls below 138 percent of the federal poverty level, which is about $16,600 a year for a single person or $33,900 annually for a family of four.
The auditor's report relied on a sampling of new enrollees.
In their letter, Johnson and Jordan, both Republicans, suggest that on the national level the expansion’s rapid growth may be partially fueled by ineligible recipients.
“The Louisiana audit raises further questions about whether the ACA Medicaid expansion’s spiraling growth results in part from eligibility errors or fraud,” the congressmen wrote in their letter.
They are seeking additional information from CMS by 5 p.m. Feb. 14.