Louisiana’s chief auditor has locked his sights on Medicaid, bolstering his office’s review of the billions of dollars spent by the health program and rolling out report after report identifying problems with oversight of that spending.
Legislative Auditor Daryl Purpera doesn’t like what his staff has found as it combs through reams of Medicaid data. He says the more than $12 billion annual program “is being run kind of willy-nilly, loosey-goosey” without tightened controls by the Louisiana Department of Health.
“I think they struggle with trying to run the program properly. It’s a big program, it’s a complex program and it’s got a lot of moving parts. And it’s pretty broken right now,” Purpera said in an interview.
That increased scrutiny has placed the health department in the awkward position of defending its management of a program that accounts for about 40 percent of the state operating budget as it touts its Medicaid expansion and increased spending on services.
The auditor’s office and health department officials say they are working together to improve Medicaid spending practices and make sure the dollars pay for the patient health care intended.
Jeff Reynolds, the health department’s chief financial officer, said he views the audit team as a “tool to help us make overall improvements to the program.”
But friction is starting to show amid disagreements about how to interpret audit findings and the use of specific data types for review.
Purpera and the health department disagreed about the auditor’s request to use state income tax returns to check people’s eligibility in the Medicaid program. Purpera told lawmakers the data would be helpful, but Reynolds said eligibility workers determined several years ago that the data wasn’t valuable to conclude whether a person met Medicaid requirements. State senators killed the legislation that would have granted Purpera’s request.
The latest audit from Purpera’s office, released two weeks ago, drew conflicting views as well. Health department leaders suggested the findings were misleading, while Purpera said the report shows taxpayers are paying for billions in services the department can’t verify were performed or should have been covered.
Auditors reviewed payments from 2012 through 2017 to the five private companies that manage care for 1.5 million Medicaid patients. The report says the health department isn’t properly checking the reliability of the claims paid to health care providers by those managed-care organizations.
“What’s most important to me is there isn’t any questioned cost there,” Reynolds said. “The data was simply not there.”
Purpera goes further, though, saying sloppy oversight makes it impossible to know if Medicaid is paying for things it shouldn’t be.
Many problems identified by auditors stretch back to former Gov. Bobby Jindal’s administration but have extended into Gov. John Bel Edwards’ administration. The Jindal administration eliminated the entire internal audit section at the health department. Reynolds said the agency has started to rebuild that.
The legislative auditor’s office regularly had a few auditors working out of the health department year-round to review financial data, but Purpera beefed up that presence about two years ago. Reynolds said the legislative auditor’s team has grown to about a dozen people, four times the health department’s internal auditing staff.
In the audits that followed, Purpera’s office said managed-care companies were paid for people who had moved away from Louisiana or had died. Auditors found duplicate payments for services and payments for services and tests that shouldn’t have been covered. Auditors said the health department doesn’t properly monitor the companies to ensure they provide enough specialists to treat Medicaid patients’ mental health and substance abuse problems.
Health department officials say they’ve made improvements in response, pointing to more recent findings that credit some of the changes with decreasing improper Medicaid payments.
“Absolutely there are areas we can improve,” Reynolds said. “Our goal is to run a perfect program and eliminate all waste, fraud and abuse, and that’s what we’re working toward.”
Purpera, however, sees fundamental problems with the determination of whether a person is eligible for Medicaid and the tracking of dollars sent to the managed-care companies.
“We’ve got a mess right now,” he said.
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EDITOR’S NOTE: Melinda Deslatte has covered Louisiana politics for The Associated Press since 2000. Follow her at http://twitter.com/melindadeslatte
An AP News Analysis