Why is Governor & Democrats Protecting Medicaid Fraud ?

Louisiana now covers one-third of the state (approximately 1.6 million people) under its $8 billion Medicaid program, and has seen its share of the cost increase from $1.7 billion in 2008 to $3.3 billion today. More alarming, new federal projections indicate Louisiana’s share of Medicaid cost will increase to over $6 billion by 2026. Medicaid is definitely the elephant in the back of the room. One would think reducing Medicaid spending would be a top priority. Unfortunately, the Governor, Senate Democrats and apparently even Senate President John Alario think otherwise.
Consider the following facts:
· The federal government breaks down Medicaid fraud into “Provider” and “Recipient” fraud, and will only reimburse states for their efforts to control provider fraud. Federal regulations seem to protect Medicaid recipients (a large voting block).
· At the October 25th Task Force on Coordination of Medicaid Fraud Detection & Prevention Initiatives meeting it was discussed how the Louisiana Department of Health (LDH) has inferior computer systems that “puts them behind the eight ball” in addressing recipient eligibility fraud – how in 2016 LDH only made 18 eligibility referrals to sheriffs -- how the State Legislative Auditor (Auditor) has found where approximately 208,000 applicants under Medicaid expansion are possibly not eligible ($1 billion of Medicaid payments may be in error) – how LDH does not appear to be on the same team as the Louisiana Attorney General (AG) and Auditor in fighting Medicaid fraud.
· Our AG, Auditor, Representatives Sherman Mack (R-Albany) and Tony Bacala (R-Prairieville) have collaborated on legislation that would (1) define Medicaid fraud to include recipient fraud (HB 88), (2) allow our AG to create a Medicaid Recipient Fraud Unit that would qualify for 50% reimbursement by the federal government (HB 163), and (3) allow tax data to be shared by the AG, Auditor and LDH in their Medicaid fraud efforts (HB 480).
· The Governor signed into law HB 88 – so everyone agrees Medicaid Recipient Fraud is illegal.
· The House passed both HB 163 and HB 480 to give the AG, Auditor and LDH the weapons to attack Medicaid Recipient fraud. However, Senate President John Alario gave them a death sentence as he sent both bills to Senate Committees (Judiciary B and Revenue & Fiscal Affairs) controlled by Democrats, and where they did in fact die.
· Senator J.P. Morrell (D, New Orleans) then offered a “Compromise bill” (SB 119) that allowed tax data to be used only by LDH in verifying Medicaid eligibility – and denying access to the tax data by the Auditor and AG (the only two agencies that are chomping at the bit to attack Medicaid recipient fraud). Remember, LDH is the agency that even the Governor’s Executive Counsel said “does not appear to be on the same team” when it comes to fighting Medicaid fraud.
· Representative Lance Harris (R-Alexandria) recently sent a letter to the Governor requesting that Medicaid fraud legislation be considered in addition to tax revenue legislation in the upcoming 3rd Special Session on June 18th – and therefore combine spending reduction legislation with tax increases. The Governor denied the request.
In summary, Medicaid fraud is a crime and may be costing over $1 billion in fraudulent payments (Louisiana’s share would be $400 million). Senate Democrats and the Governor acknowledge that Medicaid fraud is illegal, and say they are concerned - yet their actions indicate otherwise. Is it possible they are more concerned about getting re-elected than they are about the fiscal well-being of Louisiana?

Steve Gardes
Lafayette

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