Task force nears slate of Medicaid recommendations, with eyes on rooting out fraud

Nov. 29--A panel that is looking into how the state could curb fraud in the Medicaid health care program for the poor is winding down its work at the State Capitol, with a series of recommendations expected to be released in the coming weeks.

The Medicaid fraud detection and prevention task force on Tuesday set out to identify improvements that can be made through state legislation, policy changes or through seeking waivers from the federal government.

"We're talking about taxpayer money that we are entrusted with to spend properly," said Rep. Tony Bacala, R-Gonzalez. "I think that's what the public should expect of us."

The task force, created by the state Legislature, has spent the past four months taking deep dives into the state's Medicaid offerings, the Department of Health, current Medicaid fraud detection efforts through the state Department of Justice and other existing programs meant to root out wasteful spending on the health care program.

Spending on the Louisiana Department of Health, which oversees Medicaid, is about $13.5 billion each year or nearly half of the state's $28 billion budget. More than 80 percent of LDH's funding comes down through the federal government, which covers most of Medicaid costs, but relies on the states to oversee their own programs, within certain parameters.

Louisiana has repeatedly been lauded at one of the top states for investigating and recovering money that has been fraudulently spent on the program by zeroing in on providers who seek reimbursement for services that were not performed.

The Medicaid Fraud Control Unit, a division of the state Department of Justice under the Attorney General, handles most of the investigations in Louisiana.

But legislators have increasingly pushed on the department to look for ways to rein in costs, including attempts to address fraud.

One of the issues that likely will be addressed is the state's restrictions on tracking eligibility.

Under the expansion, Medicaid is now available to household that have incomes below 138 percent of the federal poverty level. That's about $33,950 for a family of four or $16,640 for a single adult.

"Lets dig in deeper and try to see to what degree are we allowing people to sign up who are not eligible," Bacala said during the task force's most recent meeting.

One of the hurdles is on restrictions of access to records between health services and the state Department of Revenue and LDH, and LDH's ability to staff more stringent follow-up reviews.

"It's a staffing issue," said state Medicaid director Jen Steele. "It really all boils down to resources for us."

She said she thinks that a cost-benefit analysis review should be part of the larger recommendation package.

Louisiana expanded its Medicaid program, under the federal Affordable Care Act, in July 2016. Since then, more than 453,000 people, mostly the working poor, have been added to the rolls under the expanded program, bring its total covered to some 1.6 million people, most of them children.

The state has been tracking various health care outcomes for the newly insured. For example: 26,200 women have been screened for breast cancer. Of them, 264 learned that they had cancer and are now getting treatment. Nearly 12,000 adults have been diagnosed with and are now being treated for hypertension. Additionally: 6,625 adults have received outpatient substance abuse treatment, and another 7,216 have received residential care.

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