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Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Louisiana Did Not Comply With Federal and State Requirements Prohibiting Medicaid Payments for Inpatient Hospital Services Related to Provider-Preventable Conditions

Submitting OIG: 
Department of Health & Human Services OIG
Report Description: 
Louisiana did not comply with Federal and State requirements prohibiting Medicaid payments for inpatient hospital services related to treating certain provider-preventable conditions (PPCs) because it did not have controls to identify claims with PPCs that would have required a reduction in claim payment. We identified inpatient hospital claims totaling $55.4 million ($34.9 million Federal share) that contained a diagnosis code identified as a PPC and certain present-on-admission (POA) codes, or the claims were missing POA codes.
Date Issued: 
Monday, December 17, 2018
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-06-16-02003
Component, if applicable: 
Centers for Medicare & Medicaid Services
Location(s): 
Agency-Wide
Type of Report: 
Audit
View Document: 
AttachmentSize
PDF icon 61602003.pdf1.2 MB
Additional Details Link: 
https://oig.hhs.gov/oas/reports/region6/61602003.asp

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
266121 Open No
We recommend that the State agency review all claims with dates of admission before our audit period (from July 1, 2012, and paid through December 31, 2012), and all claims paid after our audit period (June 30, 2017), to determine whether payments should be reduced for any claims that contained PPCs and refund to the Federal Government its share of any unallowable amounts.
Displaying 1 of 1 Recommendations