MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: Some pretty egregious examples of paying cap rates to MCOs for members who the state knew moved to other states. Can I get a PARIS file, people?
Medicaid(MGN / Medicaid)
BATON ROUGE, La. (WAFB) – The Louisiana Legislative Auditors Office released an audit report on Monday, August 21, addressing the issue of Medicaid recipients who no longer live in Louisiana.
According to the audit report, the Louisiana Department of Health paid out millions of dollars over a period of several years to cover people who did not appear to live in Louisiana or had a driver’s license from another state.
The money was paid to Managed Care Entities (MCEs) for the funds to then be distributed to Medicaid recipients, the audit report states.
According to the audit, LDH paid about $3 million to cover 380 Medicaid recipients who were identified as living outside of Louisiana by LDH’s own eligibility system. The payments were made between June 2019 and February 2023, the audit found.
One example in the audit report revealed a Medicaid recipient’s address was changed to a Texas location in LDH’s eligibility system in 2019. Despite the address change, LDH paid $80,538 to MCEs on behalf of the recipient between May 2019 and February 2023, according to the audit. The Medicaid recipient never actually received any services from Medicaid, the audit stated.
The audit also found that LDH paid about $109.5 million to cover 13,391 Medicaid recipients who obtained a driver’s license in another state. According to the audit, the money was paid out between September 2016 and February 2023.
The audit report revealed that one Medicaid recipient obtained a driver’s license in New York in October 2015. Despite that, LDH paid $102,543 to MCEs on behalf of the recipient between December 2017 and February 2023, the audit stated. The recipient did not receive any services from Medicaid.
According to the audit report, LDH could do better with its eligibility process by utilizing data to identify Medicaid recipients who are enrolled in Louisiana’s Medicaid program but only receive services from out-of-state providers.
To read the full audit report, click here.