Battle over Medicaid fraud reaching fever pitch

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A battle over Medicaid Fraud has brewing in Louisiana for over two years now between the Legislative Auditor/ Attorney General vs. the Edwards Administration (i.e. the Department of Revenue and Department of Health) and Senate Democrats.
The battle has now reached fever pitch as the Legislative Auditor (Auditor), after receiving a legal opinion from the Attorney General (AG) supporting his position, has recently filed a law suit in the 19th Judicial District Court requesting the court to require the Department of Revenue (LDR) to turn over certain 2017 state income tax return statistics of Medicaid recipients the auditor is seeking as part of an investigation into Medicaid fraud. LDR has been fighting the Auditor for months over this request on the grounds that it could violate the privacy rights of Medicaid recipients. However, the Auditor’s request was for statistics that could not have violated the privacy rights of any individual as they only requested the number of Medicaid recipients who filed state income tax returns with the LDR that showed more income than that reported to the LDH when their Medicaid applications were filed. Furthermore, the Auditor has strong grounds for making such requests since his fraud investigation is being driven by a similar analysis in 2016 that showed approximately 84,000 Medicaid enrollees could be making too much money to qualify for Medicaid (and therefore resulting in possible Medicaid fraud in excess of $420 million per year).
The Opinion 19-0030 rendered by the AG on March 18 laid out a compelling case supporting the Auditor as follows;
— Mr. Daryl Purpera, the Louisana Legislative Auditor, is also the Chairman of the Task Force on Coordination of Medicaid Fraud Detection and Prevention Initiative (i.e. the “Task Force”) which was created by Act 420 in the 2017 Regular Legislative Session. The purpose of the Task Force was to study and identify the policies, processes, laws, and rules by which the State implements Medicaid fraud prevention efforts. La. R.S. 46:440.6.
— On September 4, 2018, the Task Force sent a letter to the Secretaries of the LDR and the LDH requesting 2017 statistics based on samples of the LDH Medicaid data compared to the LDR income tax data. The LDR responded by letter on February 26, 2019 stating that “the information requested falls under the confidentiality provisions of La. R.S. 47:1508 (A)(1) - - and does not fall in the scope of the 1508 (B)(2) exception, thus, may not be provided to the Task Force.”
— The AG’s review of the facts and the relevant law resulted in his opinion that in fact LDR is not prohibited from providing the requested information to the Task Force as the “LDR’s interpretation of this statute is incorrect. Specifically La. R.S. 47:1508(B)(2) provides an exception to the confidentiality provisions and states “that nothing herein shall be construed to prevent the publication of statistics so classified as to prevent the identification of any return or report and the items thereof. Thus, since the information requested would be presented as numerical data of total recipients of each category, the statistics requested in no way identifies any individual return or report, but rather is an example of the very information excepted from confidentiality under :1508(B)(2). It is the opinion of this office that LDR may provide the information requested by the Task Force.”
LDR has subsequently ignored the AG Opinion, hence the law suit by the Auditor which elevates the battle to a new level.
However, this is only one battle. I will suggest to you that if you stop to connect the dots by looking at the other battles fought in 2017 and 2018, you will see a picture developing which clearly illustrates the Edwards Administration’s desire to expand Medicaid at all costs, including the protection of Medicaid Recipient Fraud (which is illegal, but affects many voters). We will connect those dots next week — please stay tuned!
Steve Gardes is a certified public accountant (CPA) and certified valuation analyst (CVA) with over 40 years of public accounting experience.