The Legislative Auditor released a report Monday that finds the Louisiana Department of Health needs to strengthen the processes it uses to ensure the reliability of the provider data submitted by the managed care organizations in their encounter claims.
The MCOs provide medical services for the State’s Medicaid program. Without reliable data, auditors said, LDH cannot effectively monitor the MCOs or reduce the risk of improper Medicaid payments.
Auditors looked at claims between February 2012 and December 2017. They found that LDH did not make sure that the right codes were being used; more than 190,000 claims for more than $13 million in charges. Because the right codes weren’t use, there’s no way to know if the providers actually provided the services listed in the claims, the reports state.
Auditors also found that LDH accepted claims from the MCOs for providers who weren’t listed in the Provider Registry that is required by federal law. Those claims were for $136 million in charges, auditors found. Part of the problem is that the registry doesn’t allow multiple sites for providers, but many medical providers – more than 28,000 of them in Louisiana – have multiple sites, the report states.
And, the report states, auditors found that no valid id number was used for providers in more than 350,000 claims between February 2012 and September 2015. At that time, it appears a default provider number of 999999 was used, and after that, until December 2017, a provider number of "0" was used, the report states.
Here’s the auditors’ report, if you’d like to read it for yourself.