LANDRY: In Combating Government Mismanagement and Medicaid, Trust But Verify

Last week, Legislative Auditor Darryl Purpera criticized the “willy-nilly, loosey-goosey” oversight provided by the Louisiana Department of Health (LDH) over the Medicaid program. This accurate criticism came after his office conducted an audit which exposed taxpayers footing the bill for billions of dollars on services that LDH cannot confirm were actually done or even covered by the Medicaid welfare program.

What’s more: Auditor Purpera’s team found that Gov. John Bel Edwards’ LDH is not providing proper oversight over the reliability of claims that our taxpayers are paying to Medicaid providers through the managed care organizations (MCOs).

This scathing report unfortunately does not surprise me. For the last two and a half years, John Bel and his allies have been laser-focused on political games. Instead of fixing problems, they have taken a page from the DC playbook: blame and demonize others.

While conservative legislators and I have tried to guard the taxpayers’ hard-earned money, John Bel and his cronies have all but accused us of waging war on the poor. These false attacks are coming from the same failed politicians who threatened LSU football, scared the sick in nursing homes, and used every bully tactic known to man in order to raise our taxes to fund their unsustainable government growth.

One does not need to be an auditor or mathematician to figure out what is wrong here. Under John Bel’s disastrous control, the Medicaid budget has exploded to more than $12 billion – over 40% of our entire state budget. And LDH has only a few people providing oversight of their monstrous account. The failure of oversight has allowed providers to invoice and receive our money for billable hours that are not humanly possible to perform.

John Bel’s LDH cannot tell who is doing the referring, the billing, or even providing the services. LDH has no way of knowing if Medicaid welfare recipients are actually receiving the services or if the services are even coverable. This failure of leadership has perpetuated many different fraudulent activities that keep busy my office’s Medicaid Fraud Control Unit (MFCU).

Our MFCU agents have found dozens of people who were unaware that, according to LDH payments, they had received healthcare services. We have actually found some claims being denied, yet still ultimately paid. In other cases, managed care organizations (MCO’s) made payments to those no longer living in Louisiana and to those buried in their graves.

While LDH is charged with doing background checks to ensure company compliance, they have allowed many companies to bill Medicaid despite being deemed unqualified or not having contracts with the State. In fact, one of these MCO’s without a license billed taxpayers $6.9 million in just 10 months.

Making matters worse: even when fraud is detected, LDH does not follow the rules to root out the waste. Rather than conduct on-site visits as required by policy, they settle for self-attestations – promises from the subjects that all is well. LDH does not even require the MCO’s to report whom they are contracting to provide services – making it impossible to verify if they are qualified and licensed.

In order to root out fraud, Louisiana has to be as vigilant on the front end as we are on the back end. Every provider of an MCO should be enrolled in the state system. Once providers go through the credentialing process and background check, they should also be licensed through LDH. And only those who have done the aforementioned should be able to submit invoices – which obviously should be verified to ensure the data submitted is accurate.

As the late great President Ronald Reagan believed when dealing with the Evil Empire, trust but verify. While John Bel and his allies seemingly trust everyone with our tax dollars but do not bother to verify – I will continue to do everything in my power to combat waste, fraud, and abuse in the Medicaid welfare program and beyond.

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