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July 21 07:11 AM

$3.8 Million in possible improper payments made to Medicaid HCBS programs

While the Louisiana Department of Health has improved its processes for preventing, detecting, and recovering improper payments in the Medicaid Home and Community-Based Services Programs, it could do more, the Legislative Auditor said in a report released Monday. Auditors also identified new issues with service monitoring visits and ineligible workers that could put service recipients at risk, the state auditor said.

Auditors found that about 14 percent of monitoring visits that required observation of services occurred when a worker was no present. In addition, auditors said, approximately 100 workers who provided services totaling $2.5 million were listed on the Direct Service Worker Registry for such issues as abuse, neglect, or misappropriation of recipient property.

The performance audit report is a follow-up to a report issued in 2011 that outlined several recommendations to help LDH identify and recoup more improper HCSB payments.

Besides the new concerns, auditors found that because LDH did not fully implement the recommendations made in 2011, approximately $1.3 million in improper payments may have been made.

Among the problems auditors identified:

Approximately $620,000 in potentially improper payments for overlapping services that LDH’s check system did not identify during calendar years 2011 to 2015.

Approximately $326,915 in potentially overlapping claims not identified by LDH during its back-end review process during calendar years 2012 to 2015.

Approximately 1m450 workers whose Social Security numbers matched a driver’s license with a different name.

In addition, auditors found that LDH could not ensure the work times reported by direct car workers covered only their actual arrival and departure times and not their travel time. For example, auditors identified 52,222 instances where direct care workers reported travel time as work time, at an approximate cost of $340,000. LDH also has not established a systematic financial monitoring process for all of its HCBS providers to help ensure that services billed are properly documented.

Auditors found as well that LDH did not always assess fines in accordance with its penalty policy and still does not assess penalties for first offense.

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