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Audit reveals improper billing withing Medicaid Behavioral Health program

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BATON ROUGE - A recent report from the Louisiana Legislative Auditor's Office showed improper billing practices within the Medicaid Behavioral Health program.

According to the audit, the Louisiana Department of Health, managed care organizations, and Magellan Health Services don't have adequate procedures in place to ensure that behavioral health services are properly billed, and that improper encounters and claims are denied.

The auditor's office identified that approximately $47.5 million in encounters and claims for services between December 2015 and June 2019 were paid by the MCOs and Magellan even though they didn't comply with the LDH's fee schedule. 

Officials say that number included about $38.5 million paid for 646,746 encounters and claims that were billed using incorrect modifier codes. More than $9 million paid for 647,910 encounters and claims that exceed the rates allowed by the free schedule. There was also more than $7,000 paid for 322 encounters and claims for add-on behavioral health services that lacked a primary service.

One recommendation the auditor's office had was for the LDH to ensure that the MCOs establish edit checks to ensure that behavioral health claims are not paid unless they comply with the fee schedule.

Click here to read the full audit.

LDH said Monday that the department disagreed with the audit. LDH said the audit "criticizes the Louisiana Department of Health for allowing payments above what is indicated on the fee schedule for some behavioral healthcare services."

The health department said the auditor's office failed to acknowledge "this is an allowable and accepted practice used to ensure there are enough specialized providers in each health plan’s network."

LDH says the audit also "criticizes" the department for paying providers more than what is indicated on the fee schedule for some behavioral health services.

“(This practice is) consistent with federal law and the current contracts between (Medicaid) and the MCOs," Department Undersecretary Cindy Rives said. "Such payments are not considered overpayments.”


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