BATON ROUGE, La. (BRPROUD) – A recent audit found that the Louisiana Department of Health might have misspent $14 million. The Louisiana Legislative Auditor’s office inspected behavioral health records.
LDH has improved recordkeeping, but all suggested corrections were not made. The issues affect the state’s Medicaid Behavioral Health Program.
The state made three changes to find and correct improper billing, according to LLA. Potential improper payments decreased from $10.8 million to about $600,000.
For example, providers can’t bill for more than 12 hours of services a day. According to LDH, controls now identify the person or organization providing services. But they have reinstated a quarterly report to help identify potential problems.
LDH hired a vendor to find and fix other billing issues noted in previous audits. The auditors said there aren’t enough controls to make sure bills get properly coded and paid. They noted that up to $11.3 million might have been improperly billed.
In a response to the audit, LDH said it has increased the frequency and volume of sampling. Results from the reviews will be used to make corrections.
Auditors said LDH has not added edit checks to catch and review potential billing errors. They found that LDH paid up to $2.3 million for services that might be improper or coded wrong.
Out of eight suggestions, LDH only fully disagreed with – and did not work to include – one.
Auditors recommended that LDH record stop and start times for each encounter billed. The suggestion is for certain types of services.
LDH said those times aren’t required on federal claim forms. The LDH content management system doesn’t have fields for workers to record that in.
Medicaid BHS record keeping says the times must be noted in service and progress notes. LDH said the time documented in the notes is compared to the time billed. An internal auditing system looks at that information already.
LDH also has:
- worked to make sure that certain services aren’t billed during inpatient stays
- enforced required telehealth billing requirements
- made sure telehealth requirements set by federal policy are met
- started building a new fraud detection scoring system
Click here to view the full audit report.