Covering Louisiana

Nov 4, 2013 12:51 PM by Associated Press

Audit: DHH paid $1.9M for Medicaid for dead people

Louisiana paid nearly $1.9 million last year through the state's privatized Medicaid programs for 1,727 people who were not receiving services because they had died, according to an audit released Monday.

Legislative Auditor Daryl Purpera's office looked at fees that the state Department of Health and Hospitals paid in the 2012-13 budget year for privatized Medicaid medical and behavioral health services.

Purpera's office compared payments DHH made to the Medicaid program managers to lists of the deceased obtained through another DHH office, the vital records office.

The auditors found that DHH paid $1.6 million to the five managed care organizations that oversee medical services for Medicaid patients through a program called Bayou Health. The review says DHH paid $258,000 to Magellan Health Services, the company managing addictive treatment and mental health services through the Medicaid program called the Louisiana Behavioral Health Partnership. "Approximately 53 percent of these payments were for participants who died before the programs began," the audit says. DHH's Medicaid director said the department will seek repayment from the companies by March 31.

Both Bayou Health and the Behavioral Health Partnership started in 2012, as Gov. Bobby Jindal's administration pushed to privatize many state-run health care services. In both programs, Louisiana's health department pays the companies monthly fees for overseeing the care of each Medicaid patient, similar to an insurance premium or an administrative fee, depending on the type of health care involved. DHH decides participant eligibility and enrollment, not the private companies, according to the audit.

"Based on the results of our analysis, DHH does not have a sufficient process in place for identifying deceased Medicaid participants in a timely manner," the audit says.

In a written response to Purpera's office, Medicaid Director Ruth Kennedy agreed with the report's findings, but noted that the $1.9 million overpayment "represents a tenth of one percent" of the total premiums paid per Medicaid patient per month during the audit period.

Kennedy said the health department was reviewing the records involved in the audit and then will seek to recoup all the improperly paid fees to the private companies within the next five months. About 1.4 million people are enrolled in Louisiana's Medicaid insurance program for the poor, elderly and disabled, which is financed with a combination of state and federal funds. About 900,000 of them receive medical care through the Bayou Health program.

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