Baton Rouge, La. - Louisiana recovered more than $124 million fraudulent payments in the Medicaid program in criminal and civil penalties in the Fiscal Year 2012 according to figures from the Centers for Medicare and Medicaid Services. That is the highest rate of recovery in any state in the nation at nearly 2 percent of all Medicaid dollars spent in Louisiana. On average, states recover less than 0.6 percent of their respective Medicaid budgets.
"We take fraud and abuse of the Medicaid system very seriously in Louisiana," said DHH Secretary Kathy Kliebert. "I am incredibly proud of the work of our Program Integrity division to recover funds lost through fraudulent payments and of our ever-strengthening relationship with the Attorney General's Office to go after those who seek to knowingly steal from Louisiana citizens by defrauding the Medicaid system."
Medicaid fraud cases are typically identified through investigations conducted by the DHH Medicaid Program Integrity division. The investigators work to distinguish billing errors from true fraud cases. In the event of a billing error, program staff or Medicaid billing contractor Molina conducts education or training of correct billing practices.
In the last fiscal year, the Program Integrity division recouped more than $4.5 million administratively. The Division also made 186 referrals to the Attorney General's Medicaid Fraud Control Unit for further investigation.
Attorney General Buddy Caldwell said, "Hundreds of millions of Louisiana's dollars have been recovered as a result of our work with DHH to uncover fraud perpetrated on Louisiana's Medicaid program. Holding those who abuse the system accountable will continue to be a top priority."
DHH recently restructured its Program Integrity division, including adding two additional team members focused on quick reviews based on the recommendations made by the Medicaid billing contractor. Program Integrity is being directed by the Department's recent hire, William Root, the Inspector General and Chief Compliance Officer. Root is a former Assistant Special Agent in charge of the Office of Investigations at the U.S. Department of Health and Human Services.
Additional changes are already underway at DHH's Program Integrity division, including making improvements to the methodology and technology by which the Department searches for and identifies overpayments or fraudulent payments. Mr. Root is also working closely with the Louisiana Legislative Auditor's Office to ensure the Department is meeting all of the auditor's expectations.
"We will not be a division of the state government that lives in the past," said DHH Chief Compliance Officer William Root. "We are focused on improving how we identify fraud both within our organization, if it exists, and within the state through the use of technology and intelligent design of our fraud identification systems. We have to send a strong signal to those who believe they can wrongfully profit off of the Medicaid system and steal tax dollars from Louisiana's residents. We will not tolerate fraud; it's as simple as that."
Members of the public and the health care industry are critical players in identifying and fighting fraud. Individuals who suspect or have knowledge of fraudulent behavior or billing are encouraged to report it. More information on how to fight fraud in Louisiana may be found at www.dhh.la.gov/fightfraud.
The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog, Twitter account and Facebook.