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Audit (A-06-07-00024)

10-20-2008
Review of East Louisiana State Hospital's Hurricane-Related Uncompensated Care Claims

Executive Summary

From August 2005 through January 2006, Louisiana claimed an estimated $19.8 million for services provided by East Louisiana State Hospital that did not comply with Federal and State laws and regulations or with the approved provisions of the State's uncompensated care pool plan (UCCP plan). Under section 1115 of the Social Security Act, CMS approved the UCCP plan to reimburse providers for medically necessary services provided to Hurricane Katrina evacuees and affected individuals and Hurricane Rita evacuees without other coverage. The pool, which was 100 percent federally funded, was limited to services covered under the State Medicaid plan.

Of the $8 million in costs claimed for services provided to 100 sampled patients, $7.8 million claimed for 98 patients was unallowable. These costs were for patients whose care was not covered under the State Medicaid plan, who did not receive services on the dates claimed, whose costs were paid by other sources, or whose costs were reimbursed from the Hurricane Rita uncompensated care pool but who were not evacuees.

We recommended that the State refund to CMS the estimated $19.8 million in unallowable costs claimed. Because the State's authorization to obtain Federal reimbursement for hurricane-related uncompensated care has ended, we made no procedural recommendations.

In its comments on our draft report, the State did not address our recommendation but disagreed with our findings. Nothing in the State's comments caused us to revise our findings or recommendation.

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