Madison Parish Hospital’s (MPH) Rural Health Clinic’s ability to bill Medicaid has been suspended by the Louisiana Department of Health (LDH) while allegations of fraud are sorted out.
According to a letter sent to MPH Interim CEO Dr. Donald Perry and dated January 20, 2023, the LDH Bureau of Health Services Financing stated the State Medicaid agency “must suspend all Medicaid payments to a provider after the agency determines there is a credible allegation of fraud for which an investigation is pending under the Medicaid program against an individual or entity unless the agency has good cause to not suspend payments or to suspend payment only in part.”
The letter laid out the suspension’s details, explaining it applies only to the RHC and Medicaid, while not affecting Medicare payments, and applies “to all Medicaid claims submitted” adding, “any attempt to avoid this payment suspension action by submitting claims for services performed under this (RHC provider) number through other agencies or other billing numbers shall result in termination.”
“Federal and State regulations require that Medicaid claims paid by the Louisiana Medical Assistance Program be reviewed,” the letter stated. “This is to ensure that expenditures are made in accordance with Federal and State laws and regulations. Based on the results of our claims review, it has been determined that credible allegation of fraud against your agency has been found. Code of Federal Regulations 42, &455.2.”
The letter comes only weeks after then-MPH RHC Medical Director Dr. Thomas Neumann resigned, citing problems with the hospital’s overall leadership and pointing to fraud allegations against Family Nurse Practitioner Latayatacha Ross as an example.
Although no formal charges have been made and January’s letter from LDH did not mention the allegations surrounding Ross, it did stress “the Louisiana Department of Health is not required to disclose any specific information concerning an ongoing investigation.”
Neumann’s letter was sent to Perry, Madison Journal, Louisiana Attorney General Jeff Landry’s office, the State of Louisiana Medicaid/Medicare Fraud Division, MPH legal counsel Sullivan, Stolier, Schulze Law Firm and Louisiana State Board of Medical Examiners President Lester Johnson.
Officials in Landry’s office told the Madison Journal they could neither confirm nor deny an open investigation into allegations concerning MPH.
In January’s letter, LDH specified the Medicaid suspension is for a temporary period, pursuant to Code of Regulations 42, &455.23(c), stating payment suspension would not continue after either of the following: the agency or the prosecuting authorities determine that there is insufficient evidence of fraud by the provider; the legal proceedings related to the provider’s alleged fraud are completed.
LDH also informed Perry in the letter of an appeals process the RHC is entitled to pursue by requesting an informal hearing with LDH in writing within 15 calendar days of receiving the letter. As of press time, the Madison Journal’s attempts to reach out to hospital leadership with questions concerning the appeal and steps taken to treat patients using Medicaid had not been answered. The last day to request an appeal was Sat., Feb. 4.
As for patients dependent on Medicaid, sources close to the situation said the hospital has alternate avenues for treating patients, including the possible use of its Charity Care system, but stressed the loss of billing to Medicaid could prove financially disastrous for a facility in a highly impoverished area, should the suspension continue for a significant length of time.
Meanwhile, patients exhausting all other options could possibly be forced to seek care at other facilities in nearby areas.
