Louisiana recognized for being tough on Medicaid fraud
Posted on 6/8/2017 12:13:00 PM.

The Trump Administration recognizes Louisiana as one of the toughest states on fighting Medicaid fraud. Chief of Staff with the Louisiana Department of Health Andrew Tuozzolo says they’re doing everything they can to prevent, detect, and prosecute fraud. The US Inspector General reviewed 225 cases of suspected fraud in Louisiana.

“Of all the cases that they reviewed, we had 100 percent compliance with the law of Medicaid fraud, detection, prevention, and the referrals,” Tuozzolo said.

Tuozzolo says they refer 200 to 400 cases to the state Attorney General’s Office every year, which limits the liability for taxpayers. He says they use state-of-the-art software with pattern matching algorithms to look for potentially fraudulent billing practices.

“We have numerous traps in the system to validate and confirm that is an appropriate claim that should be paid, meaning that once the claim is maid we’re going to pay the doctor for that service,” Tuozzolo said.

Louisiana was one of only four states to pass this audit since 2014. Lawmakers have suggested Medicaid fraud was one culprit of the state’s budget problems. But Tuozzollo says there’s only around $50 million in fraudulent claims annually in a $10 billion program.

“Certainly we do a very good job of recovering when we do find fraud, but the amount of fraud that’s detected is very small compared to the spending in the program,” Tuozzolo said.

The feds could not make any recommendations for Louisiana to improve fraud detection.

 
 
 
 
 
Andrew Tuozzolo, Medicaid, fraud, LDH





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