A new report from the Louisiana Legislative Auditor finds that the Louisiana Department of Health and the organizations it works with do not have adequate procedures in place to ensure services through the state’s Medicaid Behavioral Health Services programs are properly billed and that improper claims are denied.
The auditor found approximately $47.5 million in claims for mental health services between December 2015 and June 2019 that was paid by the managed care operators and Magellan Health Services even though they did not comply with LDH’s fee schedule.
The total included about $38.5 million paid for 646,746 encounters and claims that were
billed using incorrect codes for filing; more than $9 million paid for 647,910 encounters and claims that exceeded the rates allowed by the fee schedule; and $7,800 paid for 322 encounters and claims for add-on behavioral health services that lacked a primary service.
Legislative Auditor Daryl Purpera recommended in the report that the LDH and the managed care operators it works with establish edit checks to ensure that claims are not paid unless they comply with the fee schedule. In response, LDH officials stated that they disagreed with the recommendations, that they were inconsistent with a risk-based managed care mode and that there are already edit checks and review procedures in place. Read the full audit.
