This report originally appeared in the June 2010 issue of DOTmed Business News

A legislative audit on Louisiana's Department of Health and Hospitals (DHH) with regard to Medicaid acute care inpatient hospitalizations has turned up problems in oversight. The legislative auditor recently presented the report to the presidents of the state Senate and House of Representatives.

The audit results found that DHH does not currently ensure that Medicaid acute care inpatient hospitalizations are medically necessary and clinically appropriate, and found weaknesses in DHH's practices - as example, not using medical criteria to ensure every Medicaid hospitalization is necessary. Although DHH contracts with Unisys Corporation (Unisys) to act as the fiscal intermediary for the state Medicaid program, it does not require Unisys to conduct a clinical review of the admission request to determine whether it is medically necessary. The report says DHH agreed with the recommendation to conduct a clinical review of each admission request to determine if it was medically necessary.
The report further states that when criteria are used, it is outdated; DHH also does not use current guidelines for reimbursement to determine how long a patient should stay in a hospital. DHH also agrees with the recommendation that it should monitor Unisys to ensure that it uses the most current version of InterQual medical criteria. In addition, the legislative audit found that DHH may be paying for some days in hospitals due to hospital-acquired infections. DHH agreed with the recommendations that it should require providers to track and report hospital-acquired infections in the Medicaid population and to request permission from Centers for Medicare and Medicaid Services to refuse payment for prohibited hospital-acquired infections included in Medicaid claims.

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