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Up to 93 percent of Louisiana Medicaid expansion recipients may be ineligible, audit finds

By gulfsouthb32553561, Feb 1 2019 07:58PM

Two Republican lawmakers are calling for further investigation after a Louisiana Medicaid audit showed that extremely high numbers of recipients may make too much money to qualify for the program.

Sen. Ron Johnson (R-Wis.) and Rep. Jim Jordan (R-Ohio) sent a letter to Seema Verma, administrator for the Centers for Medicaid and Medicare Services alerting her of the findings and asking for answers about what CMS plans to do about it.

"If these improper (over) payments are occurring in one state, it is logical to assume overpayments are occurring in other states," the two wrote in their letter. "We respectfully request information about what the Centers for Medicare and Medicaid Services (CMS) plans to do to determine where overpayments are being made, steps CMS will take to recover overpayments, and controls CMS will put in place to ensure federal Medicaid dollars are only paid to those who qualify."

What did the audit reveal?

According to the congressmen's letter, Louisiana auditors first identified nearly 20,000 Medicaid recipients whose income was higher than the amount to qualify for Medicaid.

So, the auditors took a selection of 100 single-person households receiving Medicaid under expansion created by Obamacare. of those 100 households, 93 of them were ineligible for benefits between 2016 and 2018, and 14 of them were making more than $100,000 per year.

Next, auditors took a random sample of 100 more Medicaid expansion recipients, and 82 of those were ineligible sometime between 2016 and 2018.

According to the auditors, the state may have paid as much as $85 million for ineligible Medicaid recipients from 2016 through 2018.

How does that happen?

The auditors reported that Medicaid expansion recipients may be "lowballing their income" and then failing to provide updated information when they start making more money.

Louisiana apparently "relies on Medicaid recipients to self-report their wages," and there are questions about whether that policy violates laws that require states to ensure Medicaid beneficiaries provide up-to-date information.

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