Louisiana Report Leads Congress to Contact CMS About Medicaid Overpayments

ANCOR is sharing this article by The Advocate, a Louisiana-based newspaper, because the report it discusses has attracted Congressional interest. This has implications for the national conversation on Medicaid funding and Medicaid oversight. ANCOR will keep members informed on the pending discussion between Congress and the Centers for Medicare and Medicaid Services (CMS) as it evolves.

As shared by The Advocate:

“A Louisiana audit that suggested there could be wide-spread Medicaid misspending has prompted a probe on the federal level.

U.S. Sen. Ron Johnson of Wisconsin and Rep. Jim Jordan of Ohio penned a letter Thursday to Centers for Medicare and Medicaid Services head Seema Verma, citing a report from Louisiana Legislative Auditor Daryl Purpera as need for more information about whether there is a national Medicaid spending problem. [ANCOR Note: the first page of the Congressional letter is available online here.]

‘If these improper payments are occurring in one state, it is logical to assume overpayments are occurring in other states,’ the Republican congressmen wrote in the letter. ‘We respectfully request information about what the Centers for Medicare and Medicaid Services plans to do to determine where overpayments are being made, steps CMS will take to recover overpayments, and controls CMS will put in place to ensure federal Medicaid dollars are only paid to those who qualify.’

The Louisiana Legislative Auditor’s Office released its findings in November of an audit that found the Louisiana Department of Health may have spent an additional $85 million over 20 months on providing health care coverage for people who didn’t qualify for the Medicaid program – largely because of the self-reporting standards for employment under the state’s previous eligibility system and worker errors. Medicaid is mostly federally-funded in Louisiana, but the state administers the program.

‘Without a sufficient process to determine recipient eligibility, LDH cannot ensure that Medicaid dollars are spent appropriately,’ the auditor’s office concluded in its overview, which was presented to legislators shortly after its release.

LDH officials have noted that its release came just days before the health department announced its new modernized Medicaid eligibility system was up and running, and the audit didn’t reflect the upgrades that have been made.”