How has Medicaid expansion defrauded Louisiana insurers, taxpayers?

| Jun 4, 2019 | Insurance Law

What is one material benefit of commanding a higher salary than Louisiana Gov. John Bel Edwards?

Notably, it is still being able to establish eligibility for enrollment in Medicaid.

That might sound flatly far-fetched to readers of our insurance defense blog across Louisiana. After all, Medicaid is a national health care program that is ostensibly limited to only uninsured and low-income individuals across the country.

Nonetheless, the income restrictions applicable to Medicaid didn’t stop at least one Louisiana individual with an income surpassing the state’s chief executive from garnering program eligibility. In fact, the nonprofit Pelican Institute for Public Policy reveals that alarmingly high numbers of well-heeled state residents are wrongly enrolling in Medicaid expansion that has been occurring over the past several years.

Here’s one stunning takeaway from Pelican’s recent investigative probe: Evidence points to at least 1,600 Louisiana residents enrolled in Medicaid who make more than $100,000 annually. Most of those individuals disenrolled from private health care plans in order to take advantage of Medicaid’s comparatively lower costs.

That reality signals fraud to state regulators, with a special spotlight focusing on Louisiana’s administration of the program. It is estimated that ineligible enrollees are costing the state approximately $100 million annually. Overall, Louisiana reportedly has about 480,000 Medicaid expansion enrollees, which costs the program $2.5 billion each year.

Taxpayers are on the hook for a portion of that amount. And, of course, Medicaid insurance companies regularly pay out huge amounts of money. For obvious reasons, insurers want to see the full extent of program fraud fully spotlighted, with irregularities eliminated.