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Healthcare Journal of NEW ORLEANS
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NOV / DEC 2014
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• Achieve collective community impact
• Increase program accountability.
OIG Questions Dental Billing Services
The Office of the Inspector General has questioned
the billing practices of some Medicaid Pediatric
dental providers in Louisiana.
Using several measures, OIG identified 26 general
dentists and 1 oral surgeon in Louisiana with ques-
tionable billing who are extreme outliers when com-
pared to their peers. Medicaid paid these providers
$12.4 million for pediatric dental services in 2012.
These 27 dental providers—representing 5 percent
of the providers reviewed—received extremely high
payments per child; provided an extremely large
number of services per day; provided an extremely
large number of services per child per visit; and/or
provided certain selected services to an extremely
high proportion of children. These services included
pulpotomies—often referred to as “baby root
canals”—and extractions.
Notably, almost a third of the providers with ques-
tionable billing worked for two dental chains. A con-
centration of such providers in chains raises con-
cerns that these chains may be encouraging their
providers to perform unnecessary procedures to
increase profits. In addition, four of the providers
with questionable billing had actions taken against
them by the State Board of Dentistry.
Willis-Knighton and Humana
Partner to Launch ACO
Willis-Knighton Health System and Humana Inc.
recently announced a new Accountable Care
agreement. The new agreement is expected to
result in more coordinated care for patients and
an increased emphasis on preventive services in
Northwest Louisiana.
Humana’s newAccountable Care relationshipwith
Willis-Knighton is designed to improve the health of
worksheet, correct the formula to calculate the
discharge-related amounts, ensure that the cor-
rect cost report periods are used, and review sup-
porting documentation for the numbers provided
in the cost reports; (3) modify the patient-volume
worksheet to clarify the patient-volume calcula-
tion, review the patient-volume calculation for the
other hospitals not included in the 25 reviewed, and
refund any overpayments identified; (4) refund to
the Federal government $3,250 in overpayments
made to the 13 professionals, implement system
edits to prevent payments that exceed threshold
amounts, and ensure that personnel are knowl-
edgeable about the EHR program requirements;
and (5) work with CMS to ensure that the 13 pro-
fessional incentive payments not posted to the NLR
are posted and establish a policy to reconcile the
CMS-64 report to the NLR each quarter. DHH con-
curred with those recommendations.
HHS Awards Healthy Start Grants
HHS Secretary Sylvia M. Burwell has released $92
million in grants to help 87 organizations in 33
states reduce high infant mortality rates and other
health problems related to pregnancy and moth-
ers’ health. Among those were Crescent City WIC
Services, Inc. in Gretna ($532,933) and the City
Of New Orleans ($1,421,155). Grants were also
awarded to Family Road of Greater Baton Rouge,
Inc. ($532,933) and Family Tree Information Edu-
cation & Counseling Center in Lafayette ($532,874).
Applicants for this grant cycle were required to
design programs around five key strategies that have
been found to reduce health disparities and adverse
perinatal outcomes. All grantees are required to
undertake specific activities under each strategy:
• Improve women’s health, with a focus on access
to care
• Promote quality services
• Strengthen family resilience
Scott Announces
Impending Retirement
Peggy Scott has announced that she will retire from
Blue Cross and Blue Shield of Louisiana in July of
2015. Scott has served as Executive Vice President,
Chief Operating Officer, Chief Financial Officer and
Treasurer for BCBSLA over the past nine years.
BCBSLA announced it will use the next year to
search for a successor.
Louisiana Made Incorrect
EHR Incentive Payments
According to the Office of the Inspector General,
the Louisiana Department of Health & Hospitals did
not always pay Medicaid electronic health record
(EHR) incentive payments in accordance with Fed-
eral and State requirements. OIG says the State
agency made incorrect EHR incentive payments to
20 hospitals totaling $4.4 million.
Specifically, DHH overpaid 13 hospitals a total
of $3.1 million and underpaid 6 hospitals a total of
$1.3 million, for a net overpayment of $1.8 million.
DHH made an incorrect payment to an additional
hospital; however, OIG confirmed that the payment
had been recovered during the audit. Additionally,
the State agency did not ensure that hospitals cor-
rectly calculated patient volume for 24 hospitals,
made incorrect incentive payments to 13 profes-
sionals for a total overpayment of $3,250, and did
not report 13 professional incentive payments to the
CMS National Level Repository (NLR).
OIG recommends that the State agency (1) refund
to the Federal government $1.8 million in net over-
payments made to the 20 hospitals, adjust the
20 hospitals’ remaining incentive payments to
account for the incorrect calculations, review the
calculations for the hospitals not included in the
25 reviewed to determine whether payment adjust-
ments are needed, and refund any overpayments
identified; (2) modify the hospital calculation
From left, Kevin
Egge, Dan Paquin,
and Peggy Scott.