A Louisiana Legislative Auditor’s report reveals more than $100 million was paid for Medicaid coverage for individuals who don’t even live in the Bayou State. Data Analytic Manager Chris Magee said the payments were made to the insurance companies that provide managed care for Medicaid recipients.
“LDH paid approximately $112 million to cover people who either in its own eligibility system or in driver’s license data were indicated to be living out-of-state,” said Magee.
The audit was on data from 2016 to February of this year.
Magee said the Louisiana Department of Health cites COVID as one reason for the oversite. During the pandemic the federal government would not allow states to end Medicaid coverage for recipients, however, living out-of-state was an allowable reason to end coverage.
“The issue is that LDH kind of had to go a step further, instead of just being able to validate it through a data match they had to reach out and get confirmation from the person. And that’s where it became a little more complicated during the pandemic,” said Magee.
Another problem the audit uncovered is that the health department does not use driver’s license data to identify individuals who’ve moved out of state. As a result, Magee said their office is recommending the offices share such data and LDH has agreed to do so going forward.
As for recovering the millions spent on out-of-state recipients, because the program is federally driven Magee said the state was following eligibility rules. He said only if it’s proven an individual committed Medicaid fraud can those funds be recouped.
“That’s what makes this really important to do everything we can on the front end to prevent dollars from going out the door that shouldn’t go out the door,” said Magee.
Magee said a previous audit revealed that providers were providing services for out-of-state recipients and that prompted this to see if out-of-state recipients were receiving coverage.
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