KENNEDY: Just The Facts On Medicaid Fraud

In the popular 1960s TV show Dragnet (perhaps America’s first realistic cop show), police Sgt. Joe Friday always cautioned witnesses he wanted “just the facts.”  The phrase “just the facts, ma’am” became an American idiom. The following are “just the facts, ma’am” about Louisiana Medicaid fraud.

In 2008, according to the Legislative Fiscal Office, Louisiana spent $6 billion on Medicaid  (18.6% of the entire state budget).  $4.4 billion of that was federal money and $1.5 billion was state money.  In this fiscal year budget, we will spend $12.4 on the program (36% of the entire state budget).  $9.1 billion is federal money and $3.3 billion is state money.

In 2012, Dr. Donald Berwick, President Obama’s Director of CMS, which regulates Medicaid, testified to Congress that 10% of all Medicaid and Medicare spending was lost to waste and fraud.

In 2018, the Louisiana Legislative Auditor issued a report identifying massive wasteful Medicaid spending and sharply criticized the Louisiana Department of Health (LDH) for its lax monitoring of the program’s spending.

Also in 2018, during the regular legislative session, the Louisiana Senate killed a House-passed bill that would have given the Legislative Auditor the authority to stop fraud in the program.

Talk’s cheap.  Here are actual, real-life, specific examples of Medicaid fraud identified by the Legislative Auditor:

Medicaid Recipient Income Improper Medicaid Payment by LDH Payment period
Recipient 1 $155,840 $11,531 7/1/16-8/1/17
Recipient 2 $73,082 $9,991 7/1/16-6/1/17
Recipient 3 $311,069 $9,375 7/1/16 -3/1/18
Recipient 4 $100,568 $8,905 7/1/16-6/1/17
Recipient 5 $83,712 $8,890 7/1/16-6/1/17
Recipient 6 $88,859 $8,820 7/1/16-6/1/17
Recipient 7 $80,300 $8,665 7/1/16-6/1/17
Recipient 8 $124,227 $8,452 11/1/16-8/1/17
Recipient 9 $112,187 $6,221 7/1/16-10/1/17
Recipient 10 $110,854 $5,729 8/1/16-7/1/17
Recipient 11 $58,222 $5,677 1/1/17-12/1/17
Recipient 12 $53,688 $5,563 10/1/16-9/1/17
Recipient 13 $390,968 $4,923 12/1/16-11/1/17
Recipient 14 $94,541 $4,208 2/1/17-2/1/18
Recipient 15 $89,165 $3,663 1/1/17-9/1/17

For example, from 7/1/16 to 3/1/18, LDH paid $9,375 in Medicaid benefits for Recipient 3 in the chart above.  During that time, Recipient 3 had income of $311,069.

Americans will happily pay for your doctor if you are too poor to be sick.  I’m proud of that.  But I’m neither happy about nor proud of the fraud tolerated by LDH.

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