Louisiana regulators’ response to broad-based Medicaid fraud

| Jun 27, 2019 | Insurance Law

It’s a $100 million annual fleecing of Louisiana taxpayers and insurers paying out Medicaid claims. And it reportedly involves legions of insureds who come nowhere close to actually satisfying the threshold income requirements for garnering eligibility.

We reported on the “stunning” results of a Medicaid-focused investigative probe in a recent blog post. We noted in our June 4 entry that “alarmingly high numbers of well-heeled state residents are wrongly enrolling in Medicaid expansion that has been occurring over the past several years.”

Louisiana lawmakers – and, of course, defrauded insurers – want to see the ruse stopped. One researcher and public policy expert terms the reality of mass outlays being expended on persons making Medicaid claims who don’t pass eligibility muster a “moral hazard.”

What especially galls many commentators on the matter is the fact that high numbers of people with notably high incomes who were granted Medicaid eligibility already had health policies. Their mass applications have overwhelmed processors and made things notably difficult for lower-income individuals and families that truly do qualify for Medicaid.

“We are spending taxpayer dollars to subsidize people who already had health insurance,” notes the above-cited public policy principal.

Clarity and needed change now seem forthcoming in the wake of state congressional action. Louisiana House Bill 72 recently passed through chambers and is now being considered in the senate. HB 72 seeks to give regulators expanded auditing power over the Medicaid program. If enacted, a tandem bill in the senate (SB 179) would provide for close scrutiny of current Medicaid recipients with over-the-threshold incomes.

The widespread program irregularities are widely harmful for a diverse demographic across Louisiana. Fraud and abuse in the state’s Medicaid program will hopefully be fully identified and strongly responded to without delay.