Monday, April 2, 2018

Setting record straight on Medicaid fraud

Results from a recent federal audit of Louisiana’s Medicaid program emphasized the state is both compliant with all federal fraud reporting requirements and has the proper procedures in place to detect and report fraud. The federal audit sets a high bar for its anti-fraud efforts, making it notable that Louisiana was one of only four states to pass this audit since 2014.

This fact is contrary to a letter published earlier this week in The Advocate that claimed Louisiana does not have a “working Medicaid fraud prevention system in place.” This claim is inaccurate. In truth, Louisiana is a national leader in Medicaid fraud prevention. The audit by CMS is also clear evidence that the writer provided an inappropriate assessment of the current program.
The writer misused a national statistic to make the false conclusion that Medicaid recipients are committing fraud to the tune of $1 billion. This is blatantly incorrect.
First, for accuracy, the statistic cited comes from the Centers for Medicare & Medicaid Services. CMS makes it clear their statistic is not a measure of fraud. Instead, it is a measure of payments made in error to providers. Errors can include missing documentation or incorrect coding on a claim for payment of health care services provided, in addition to intentional and illegal claims for payments.
If the writer had read to the end of the CMS report, he would have learned that Louisiana’s Medicaid payment error rate is below the national error rate. When errors do occur, Medicaid recoups the improper payment to a health care provider by withholding the amount of that payment in the next billing cycle.
Second, improper payments to health care providers are not fraud, and they are not attributable to Medicaid recipients. The Medicaid program makes zero payments directly to recipients. Zero.
It is imperative that your readers get the facts when it comes to what state government is doing to prevent Medicaid fraud. Mischaracterizations of provider payment errors as recipient fraud is wrong and a deliberate attempt to misinform readers of The Advocate.
Jen Steele
Medicaid director, Louisiana Department of Health
Baton Rouge

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