Audit finds state Medicaid program paid $700K for dead recipients over 4 years

BATON ROUGE, LA (WAFB) - The Louisiana Department of Health has improved the number of improper payments for deceased Medicaid recipients over the last four years but still has work to do, according to a new report from the state's Legislative Auditor.

The report released Monday says LDH made $717,820 in improper payments for 712 Medicaid recipients between July 2013 and August 2017. That number is an improvement over the Legislative's Auditors October 2013 report that found LDH had paid about $1.85 million in per member per month fees for 1,727 deceased individuals between February 2012 and June 2013.

"Auditors found that LDH improperly paid $637,745 in per member per month fees for 203 deceased Medicaid recipients between July 2013 and August 2017. The Department also made $80,075 in fee-for-service payments directly to providers who submitted claims for services provided to 517 deceased Medicaid recipients," the report says.

Auditors also say they also found that the organizations responsible for administering the Medicaid program paid $42,602 for services involving 181 recipients that occurred after the recipients had died. 53 percent of that amount or $22,879 went to pharmacy providers, the audit found.

LDH administers the Medicaid program for Louisiana. The purpose of the program is to provide health and medical services for uninsured and medically-indigent citizens. In 2012, LDH moved the program to a full-risk prepaid managed care model from a fee-for-service model.

Under LDH's current model, called Healthy Louisiana, it pays a fixed per-member-per-month fee that is essentially an insurance premium to the managed care organization for administering health benefits. LDH has contracted with five MCOs to operate Healthy Louisiana through January 31, 2018.

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