BATON ROUGE, La.
Audits of in-home health providers who care for Louisiana Medicaid patients turned up insufficient documentation for worker training, a lack of criminal background checks on employees, timesheet discrepancies and outright fraud, state health officials said.
The 41 companies reviewed by an accounting firm owe the Department of Health and Hospitals $4.2 million in overpayments and fines, said Kimberly Sullivan, the program integrity chief for the state's Medicaid program.
The reviews, conducted over the fiscal year that ended in July, were part of a DHH program to combat fraud estimated to siphon off millions from the Medicaid program each year. The department is sending providers notifications of the audit findings this month.
"This was a DHH initiative to go in and look at as many of these providers as we could to really get a feel of what fraud and abuse was out there," Jerry Phillips, undersecretary of the department, said Wednesday. "We've been getting repeat findings by the legislative auditor in these areas, so we know this was an area that needed our attention."
The health department will use the audit findings to change its monitoring policies with home health care providers, who care for elderly and disabled residents with tasks that range from helping with baths and meals to hours of constant monitoring. The programs are paid through Medicaid, a government-run insurance program funded with a mix of state and federal dollars.
Phillips said the department will roll out its first changes within the next month to try stopping the abuse. For example, one change will require workers to call in every time they arrive at a home so there is a record of them showing up to provide care, he said.
"It's very difficult to police this kind of provider, because you have individual workers going in individual homes," Sullivan said.
In recent years, in-home service programs through Medicaid have grown substantially as advocate groups and DHH leaders push to keep people out of institutions, nursing homes and developmental centers when they can be cared for at home or in their communities.
The audits, conducted by private contractor Postlethwaite & Netterville, were the first in-depth review of the home health care services. The department conducts random audits of providers and investigates complaints, but rarely does the type of on-site reviews the accounting firm did, Sullivan said.
Sullivan said the same types of issues cropped up across the audits, including insufficient documents to show the required worker training, a lack of criminal background checks on employees and inconsistencies in timesheets when matched to claims filings. Also a repeating problem, she said, was that workers weren't following the care plans mapped out for their elderly and disabled patients.
Any audits that raised concerns about intentional fraud are being referred to Attorney General Buddy Caldwell's office for review by his Medicaid fraud unit.
Louisiana DHH: http://new.dhh.louisiana.gov/