DHH, lawmakers respond to audit showing Medicaid fees for the de - FOX 8 WVUE New Orleans News, Weather, Sports

DHH, lawmakers respond to audit showing Medicaid fees for the dead

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NEW ORLEANS, La. - In a state with large numbers of uninsured people, more than a million individuals or families get government-funded healthcare. But the state's legislative auditor said not all who benefited from Louisiana's Medicaid Program over the past year-and-a-half were among the living. And the blame is falling on the Department of Health and Hospitals.

"What they weren't doing is going to the vital statistics on a timely basis and making the comparison to those individuals that they had claimed to be, or held to be eligible," said Legislative Auditor Daryl Purpera.

DHH administers the Medicaid Program. In 2012, DHH implemented the Louisiana Behavioral Health Partnership and the Bayou Health Programs and is responsible for determining eligibility for those programs.

But the audit made a stunning finding.

It said DHH paid about $1.85 million in participant fees for 1,727 deceased individuals in the Louisiana Behavioral Health Partnership and Bayou Health Programs between February 1, 2012 and June 30, 2013.

"The problem actually lies at DHH, not with the partners," said Purpera.

More than half of the payments were for participants who died before the two health service programs began.

"Fifty-three percent of the deceased individuals were actually deceased before they were declared to be eligible," Purpera said.

The audit said DHH does not have sufficient processes in place for identifying deceased Medicaid participants in a timely manner. And auditors found that some payments identified may have occurred because DHH automatically enrolled participants who were Medicaid eligible prior to February 2012 into the new programs without verifying whether they were still alive.

DHH Secretary Kathy Kliebert said the state's managed care systems are fairly new and they welcomed the scrutiny. Still, she points the finger of blame at Social Security data.

"I was rather surprised in terms of the number of individuals that were showing up as deceased that we were continuing to pay management fees for, but when we looked into it, we recognized that it was really from the faulty database from Social Security," Kliebert said. "We use Social Security to determine Medicaid eligibility for some of our participants, so by using that database to determine eligibility, we also use it to determine when they're not eligible - including when somebody dies. It was a very backlogged system."

Kliebert said DHH will get the money back.

"We're going to recoup 100 percent of the funds," she said. "Already out of the 1,700 that were identified, we've already reconciled 1,300 of the records."

Still, the blunder does not sit well with state lawmakers who said Monday that the fees paid for the dead could have been spent on healthcare services in their communities.

Sen. J.P. Morrell, D-New Orleans, lamented changes in mental health services for young people within the city.

"One-point-85 million dollars being spent on the dead, and how much would it cost to have those adolescent health beds back in the Greater New Orleans area, servicing New Orleans, Jefferson, St. Bernard, Plaquemines - it's a tremendous amount of waste, and it's very discouraging," said Morrell.

"We recently have undergone the most dramatic transformation of health care delivery in this state, in our history - over the last, you know, 14 months, but that's still no excuse for DHH to be awarding, you know, payouts to people who are no longer with us," said Sen. Norbert "Norby" Chabert, R-Houma.

"Our Department of Health and Hospitals needs to do a better job of making sure those individuals that are enrolled in the program are actually individuals who are eligible to be enrolled in that program," said Purpera.

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