By Nolan Mckendry | The Center Square
(The Center Square) — Louisiana Medicaid providers considered more vulnerable to fraud or improper billing will face more frequent state reviews under a new oversight plan from the Louisiana Department of Health.
The changes apply to provider categories LDH considers “high risk,” including durable medical equipment suppliers, home health agencies, hospice providers and personal care services providers. Some high-risk providers will now have to renew, or revalidate, their Medicaid enrollment every three years instead of every five.
The department said it will also expand provider verification, use data analysis to spot unusual billing patterns and work more closely with state and federal program integrity agencies.
“Every taxpayer dollar entrusted to Medicaid should be spent on delivering care to Louisianans who need it,” LDH Secretary Bruce Greenstein said in a statement. “The best way to protect taxpayer dollars is to put strong safeguards in place before problems occur. These help ensure Medicaid resources are being used as intended.”
A May 22 letter from LDH Medicaid Executive Director Seth Gold to Centers for Medicare and Medicaid Services Administrator Mehmet Oz gives more detail about the state’s plan than LDH’s public announcement.
In the letter, LDH said it will revalidate all high-risk providers over the next two years and prioritize providers that have not been screened or revalidated within the last 12 months.
The priority list includes personal care assistants, personal care services, mental health rehabilitation providers, durable medical equipment suppliers, non-emergency medical transportation providers, providers without National Provider Identifier numbers, and providers flagged through complaints, investigations, data analysis or unusual billing patterns.
LDH also said it intends to seek federal approval to temporarily stop new durable medical equipment and home health agencies from enrolling in Louisiana Medicaid.
That would not remove existing providers from the program. But it could temporarily block new providers in those categories from joining Medicaid while the state reviews the risk of fraud or improper billing.
The department said hospice providers are already affected by a similar federal process because Louisiana requires hospice providers to be enrolled in Medicare before they can enroll in Louisiana Medicaid.
The state’s plan comes as federal officials continue to focus on health care fraud. The U.S. Department of Health and Human Services Office of Inspector General reported that Medicaid Fraud Control Units nationwide recovered nearly $2 billion in fiscal year 2025 and reported 1,185 convictions, including 856 fraud convictions.
The office said fraud convictions involving personal care attendants outnumbered any other provider type. Personal care services are among the categories Louisiana is now placing under closer review.
Louisiana has had its own Medicaid fraud cases. In February 2025, a Shreveport counseling service and the estate of its deceased owner agreed to pay $4.6 million to resolve allegations that the company billed Medicaid for crisis intervention services that were not provided.
Federal prosecutors said the company used Medicaid recipient information to bill for services that did not happen. Prosecutors also said some counselors were told to write generic notes that could be copied into patient files. The settlement resolved allegations only and did not include a determination of liability.
Under federal Medicaid rules, providers are placed into risk categories: limited, moderate or high. High-risk providers can face license checks, database reviews, site visits, criminal background checks and fingerprinting.
Providers that fail to complete revalidation on time can be removed from Louisiana Medicaid until they meet enrollment requirements.
LDH said the goal is to focus oversight on areas with the highest risk while allowing legitimate providers to continue delivering care.