It would sure seem that way given the sycophantic treatment the Louisiana Department of Health gets in this AP story with the rather “Nothing to see here, folks, move along” headline of “Louisiana Medicaid program misspent $3.8 million, audit finds” at NOLA.com…
Louisiana’s health department spent up to $3.8 million on improper payments in recent years on programs that help the elderly and people with disabilities stay in their homes, according to an audit released Monday (July 17).
The review from Legislative Auditor Daryl Purpera’s office said the Department of Health hasn’t fixed several of the problems identified in a 2011 audit of Medicaid spending on home- and community-based services.
Though some recommendations were followed, auditors said the health department needs to improve its tracking and monitoring of direct care workers and the services billed to the Medicaid program to make sure people are getting the services charged to the state.
The report identified up to $1.3 million in improper spending on overlapping claims and services from 2011 through 2015, tied to uncorrected problems described in the 2011 audit.
New problems were also found. Auditors said they identified 100 workers who charged for $2.5 million in services though they were banned from the programs because of previous findings of abuse, neglect or other problems.
And here’s the punchline…
The dollars are a small slice of annual spending on the Medicaid programs reviewed. The audit says Louisiana spent $749 million in state and federal dollars in the 2015-16 budget year on the programs, which provided services to nearly 34,000 people.
So your take in reading just the headline is probably “Meh – for as much money as the state spends on Medicaid, $3.8 million in waste doesn’t seem like a lot.” But you read the article and realize this is $3.8 million just on a tiny fraction of Medicaid spending – it’s just on nursing care for elderly and disabled living at home, and in that small segment of the population there was $1.3 million in fraud from 2011 through 2015 and the problem tripled when the audit found the repeat-offender fraudsters finding their way back to the government trough thanks to Louisiana Medicaid’s poor controls.
Which the AP quickly informs you is still small potatoes given the $750 million ocean Medicaid home and community based services constituted in Louisiana.
But the numbers aren’t the issue. The sloppiness of the procedures are the issue. From the audit…
- Although LDH implemented an edit check to prevent direct care workers who work for two different companies from claiming overlapping times for different recipients, a more comprehensive edit is needed. We identified approximately $620,000 in potentially improper payments for overlapping services that the edit did not identify during calendar years 2011 to 2015.
- LDH has not implemented an effective process to prevent payments to providers while recipients were hospitalized or in nursing facilities. We identified $326,915 in potentially overlapping claims that were not identified by LDH during its back-end review process during calendar years 2012 to 2015.
- Since July 2014, LDH has required that direct care workers provide full Social Security numbers (SSN) to help ensure that workers who have been excluded from Medicaid are not providing services. However, LDH should ensure that workers provide valid SSNs, as we compared SSNs collected by LDH to driver’s license data from the Office of Motor Vehicles and found approximately 1,450 workers whose SSNs matched a driver’s license with a different name.
- LDH has not fully implemented the use of a call-in system to capture actual time worked and reduce instances of improper payments. As a result, LDH could not ensure that direct care workers were reporting their actual arrival and departure times. We identified 52,222 instances where direct care workers were required to travel from 10 to 100 miles between two different locations where they worked consecutive hours and did not indicate travel time at an approximate cost of $340,000.
- Although LDH has developed a process to monitor LT-PCS, it has not implemented a systematic financial monitoring process over all HCBS providers to help ensure that services billed are supported with documentation. Financial monitoring, including periodically verifying claims to supporting documentation, would help LDH identify additional improper payments.
Needless to say, this is no way to run a railroad.
Why would the AP and NOLA.com want to minimize slack fiscal management by the Department of Health? These abuses happened while Bobby Jindal was governor, after all. Rebekah Gee wasn’t running the department then.
Medicaid expansion, that’s why.
Medicaid is some $13 BILLION out of the state’s budget now, as NOLA.com reported in April, which is up considerably since Gov. John Bel Edwards took office and signed Louisiana up for the program. You now have over 400,000 more people enrolled in the program, many of whom formerly had private health insurance. And they’re now hooked up to a government entitlement program which pays doctors a pittance in reimbursement for services and is wide open for fraud like that found in this audit. It’s been estimated that more than 10 percent of what Medicaid pays out is money the program is defrauded out of, which would now come to over $1.3 billion dollars – which is money we can’t spend on roads, higher education, cops, TOPS, economic development or coastal restoration.
And this is how that fraud leaks money out of that system – people screwing Medicaid out of pay for hours they didn’t work, people using fraudulent social security numbers so they can goldbrick the system, people double-billing for home care when the patient is in the hospital, and so on.
Four million dollars, with more than half of it coming via crooks who’d already been banned after being caught trying to cheat the system finding their way back in, going out the door just in one small piece of Medicaid is an outrage. That $4 million is certainly not the sum total of how Medicaid is being screwed from those home and community based services; it’s just a sliver the audit looked at. There is certainly more fraud and waste to be found out of that pool of $750 million; everyone – even the AP and NOLA.com – knows it.
Now the program has grown, and so will the waste and fraud. Everybody knows that, too. Why the AP and NOLA.com think it’s a good idea to try to minimize it is hard to understand unless they’re trying to pre-emptively defend Edwards’ decision to expand Medicaid, in which case it all makes sense.