November 17, 2003 DHH Recognized for Fraud and Abuse Controls

Baton Rouge, Louisiana, Nov 17, 2003 -

Baton Rouge – In an audit of Louisiana’s ability to fight fraud and abuse in its Medicaid program, the federal Centers for Medicare and Medicaid Services (CMS) concluded the Department of Health and Hospitals’ efforts have been successful and the results have been impressive. The review also did not find any potential vulnerabilities for fraud or abuse in the state’s Medicaid program.

The audit was conducted in June 2003, and LDH received the results last week. In its Review of Louisiana Medicaid Program Integrity Procedures, the CMS reviewers stated the 1997 passage of Program Integrity Law "has had a significant impact on all Louisiana Medicaid providers. The Law has significantly improved the state’s ability to obtain information from providers and to take action against providers who failed to meet the provisions of the law."

"In 1996, we declared war on fraud and abuse," said LDH Secretary David W. Hood. "This review shows that not only did we take the right steps back then, we have succeeded in making it more and more difficult for unscrupulous health care providers to rip off Medicaid or the taxpayers who fund the program."

One purpose of the review was to determine whether Louisiana’s program integrity procedures satisfy the fraud and abuse requirements of the Code of Federal Regulations. The review also looked at how LDH identifies, receives and uses information about potential fraud and abuse involving Medicaid providers, and the reviewers studied the Medicaid Fraud Control Unit located in the Attorney General’s Office.

"We are extremely pleased that CMS recognized our program integrity law as being an exemplary practice," said Hood. "In citing the law, CMS said it has significantly improved our ability to obtain information from providers and to take action against anyone who might pose a risk to Medicaid."

Hood also pointed out the audit demonstrated coordination between LDH and the Attorney General that has resulted in stronger fraud and abuse controls.

"CMS determined the Attorney General’s Medicaid Fraud Control Unit has followed our recommendations for changes that stop or limit fraudulent practices," he added. "Our staff has identified several loopholes, and the interagency cooperation has resulted in these loopholes being tightened."

The full report is on the LDH Web site, and can be accessed at http://www.dhh.state.la.us/reports.asp?ID=1&Detail=78