After an audit found Louisiana's Medicaid program misspent up to $85.5 million from 2016-18, two Republican lawmakers wrote a letter to CMS seeking information to determine if similar issues are occurring in other states, The Advocate reports.
The audit looked at Medicaid enrollees new to the program since Louisiana expanded Medicaid. In one sample of 100 Medicaid enrollees with the highest wages, 93 percent did not qualify for Medicaid at some point between July 1, 2016, and March 31, 2018. A random sample of 100 Medicaid expansion enrollees found 82 percent did not qualify for Medicaid coverage at some point during the survey period. Auditors concluded the Louisiana Health Department may have misspent anywhere from $61.6 million to $85.5 million on ineligible enrollees due to a faulty wage verification process.
"If these improper (over) payments are occurring in one state, it is logical to assume overpayments are occurring in other states," Sen. Ron Johnson, R-Wis., and Rep. Jim Jordan, R-Ohio, wrote to CMS Administrator Seema Verma.
The lawmakers requested information on how CMS is responding to potential Medicaid eligibility fraud, whether the agency plans to recoup the misspent dollars, and which states allow self-reported wages to determine Medicaid eligibility, among other details.
Louisiana implemented upgrades to its Medicaid eligibility system shortly after the audit was released, according to The Advocate. Read more here.
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