OIG Finds Louisiana Made Improper Capitation Payments for Inmates

An HHS Office of Inspector General audit found Louisiana made unallowable Medicaid managed care capitation payments on behalf of enrollees who were incarcerated, a period during which federal rules generally bar most Medicaid payments. The finding affects the Louisiana Medicaid agency and its contracted managed care organizations, which received per-member payments despite enrollees' incarceration status. OIG reports are typically followed by recommendations that the state refund the federal share of improper payments and strengthen eligibility verification processes to flag incarcerated individuals. The report underscores ongoing program integrity gaps in how states and MCOs reconcile enrollment data with correctional facility records.

Managed Care · Finance