Recent reviews of the five private health plans administering the Louisiana Department of Health’s Medicaid Healthy Louisiana (or managed care plans) found inaccurate records for the providers enrolled in each of the respective health plans.
Per the contracts with the state Medicaid program, the MCOs are required to maintain accurate provider directory data, with an accuracy rate of no less than 90 percent. With all plans having error rates exceeding 10 percent, the department has fined each health plan $50,000. This requirement was strengthened in the contract as part of the extension approved by the Legislature in December of 2017. Under the revised contracts, LDH can conduct similar reviews and levy fines to the MCOs for further noncompliance.
The reviews, conducted by Medicaid’s provider relations team, found inaccuracies in the online data used by recipients to search for providers and make appointments, including primary care, specialists and behavioral health. The information is also used to indicate if the provider is accepting new patients or not.
Preceding the recent Louisiana Legislative Auditor report, the Medicaid provider relations team conducted more than 500 calls to providers in May and June 2018 to determine the accuracy of the provider directory data. Medicaid conducts these reviews on an ongoing basis quarterly.
Dr. Rebekah Gee, secretary of the Louisiana Department of Health, said Medicaid relies on its private contractors to effectively and efficiently manage the Healthy Louisiana program that covers approximately 1.6 million Medicaid members.
“As our agency works to ensure the financial integrity of our Medicaid program, we are aggressively looking to our private partners to ensure their members not only get the right care at the right time, but that they have the proper administrative oversight of the program,” Gee said. “Failure to meet these minimum standards will result in continued monetary penalties.”
Medicaid notified each MCO of their $50,000 penalty, and the plans had until July 10 of this year to correct the inaccurate data identified during the LDH reviews. All MCOs met the required deadline.
“Accurate provider lists are crucial to consumers. We know that when choosing a health plan, people look to the provider list. Studies show that people want to know what doctors and hospitals are in each plan,” added Gee. “We are pleased that each plan has corrected their list, but we will continue to monitor this and other requirements for full compliance with their contracts.”
Information on the prior penalties that have been assessed to each MCO can be found on the LDH website at http://ldh.la.gov/index.cfm/page/1610