Louisiana strengthens Medicaid provider oversight

BATON ROUGE, La. – The Louisiana Department of Health is implementing enhanced provider oversight measures designed to strengthen Medicaid program integrity, protect beneficiaries and ensure taxpayer dollars are spent appropriately. The initiative includes more frequent reviews of high-risk providers, expanded provider verification requirements, enhanced monitoring and data analytics, and closer coordination with state and federal program integrity partners. “Every taxpayer dollar entrusted to Medicaid should be spent on delivering care to Louisianans who need it,” said LDH Secretary Bruce Greenstein. As part of the initiative, LDH will conduct off-cycle reviews of all designated high-risk providers that have not undergone a recent revalidation. Certain provider categories identified as presenting elevated program integrity risks will now be revalidated every three years instead of every five years. High-risk providers include durable medical equipment suppliers, home health agencies, hospice providers, personal care services providers and others identified through state and federal risk assessments. The department will also expand verification activities that help ensure participating providers are properly licensed, actively operating, and meeting enrollment requirements. Existing safeguards include site visits, ownership disclosure reviews, exclusion screenings and fingerprint-based criminal background checks for designated high-risk providers. LDH says it will work more closely with the Louisiana Office of Inspector General and other program integrity partners to analyze claims data, identify unusual billing patterns and detect potential concerns earlier. Additionally, the department is aligning with current federal provider enrollment moratoriums for certain high-risk provider categories, including durable medical equipment and home health providers.

Related reading:

• Ohio Gov. DeWine signs executive order aimed at Medicaid fraud.
• Florida Medicaid also issues moratorium on new DME suppliers.