Shreveport couple may have violated Louisiana Medicaid law
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A Louisiana Legislative audit has found a Shreveport couple may have violated state law by failing to notify the Louisiana Department of Health of changes to their household income.
The audit found that Paul and Amanda Bratlie, husband and wife, failed to notify LDH of changes to their household income. As a result, the Bratlies and their children continued to receive Medicaid coverage after their household income exceeded Medicaid program limits.
The report said LDH paid $45,352 for monthly premiums to Managed Care Organizations (MCOs) on behalf of the Bratlies and their children, and the MCOs paid providers $9,713 for covered health care services from October 2016 to September 2019. The report also said had they informed LDH of changes to their household income, the Bratlies and their children may have been ineligible to receive Medicaid benefits from October 2016 to September 2019. By failing to notify LDH of changes to their household income, the Bratlies may have violated state law.
The audit from Daryl Purpera’s office began in 2019.
LDH used tax return data from the Louisiana Department of Revenue to identify Medicaid recipients who reported income in excess of $100,000 during tax year 2017. The list of recipients who met these criteria was provided to the auditor in April 2019.
The Bratlies were included on this list and chosen for review by the auditor’s office because it was determined that Paul Bratlie had income from self-employment that was not reported to LDH.
During the investigation, auditors spoke with Amanda Bratlie on Sept. 12, 2019. She said they applied for benefits after her husband lost his job in 2015. She said her husband had been selling real estate for the past four years and that they probably earned more than $100,000 during 2017.
Medicaid records show the Bratlies visited their local Medicaid office the following day and requested, in writing, that their Medicaid cases (for all household members) be closed because, “We are no longer eligible and have private insurance.” As a result, LDH closed Medicaid coverage for all household members.
MORE: 64K deemed ineligible stay on Louisiana Medicaid because of coronavirus
Paul Bratlie told the Auditor’s Office that he initially applied for Medicaid coverage after he lost his job. He said he went to the federal marketplace and applied for insurance, and they sent him to Medicaid. He told auditors he was unaware that he had to inform LDH of changes to his income and only recalled receiving insurance cards (via mail) from LDH. He also said he obtained private insurance and stopped his Medicaid coverage in June 2019 after he provided his income tax return to LDH.
What happens next
The Legislative Auditor’s Office recommended LDH management seek legal counsel to determine the appropriate action to be taken, including recovery of payments for improper Medicaid benefits.
The Auditor’s Office also said LDH management should:
- Strengthen its processes for determining eligibility by verifying all critical eligibility factors (e.g., income, household size) rather than relying on a recipient’s self-attestation
- Ensure its caseworkers redetermine eligibility when they receive information that may affect a recipient’s eligibility
- Use federal and/or state income tax data when making eligibility determinations
- Ensure that caseworkers fully document information used to make eligibility decisions
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