Louisiana will turn to AI to detect Medicaid fraud, health officials say
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The University of Louisiana at Lafayette is developing an artificial intelligence and data analysis tool the Louisiana Department of Health will use to fight “fraud, waste and abuse,” state officials said.
This story was originally published by the Louisiana Illuminator.
On his first day on the job Monday, Louisiana Department of Health Secretary Bruce Greenstein announced the launch of two initiatives – one to target Medicaid fraud and another to reduce the number of overdose deaths during pregnancy.
The University of Louisiana at Lafayette is developing an artificial intelligence and data analysis tool the Louisiana Department of Health will use to fight “fraud, waste and abuse,” state officials said. The university is developing the technology that could be deployed within a week to begin looking for instances of fraud in the Medicaid program, ULL Vice President for Research Ramesh Kolluru said in an interview.
“We are committed to improving government efficiencies in Louisiana using innovation,” Kolluru said. “Our first mission … is to improve efficiency and integrity of the Louisiana Medicaid program.”
The state health department has created a “Fighting Fraud, Waste and Abuse” task force to detect wrongdoing within Medicaid, Undersecretary Drew Maranto said. The agency will partner with LA DOGE, Louisiana Gov. Jeff Landry’s version of Elon Musk’s controversial Department of Government Efficiency. A Medicaid fraud control unit already exist
The AI technology is being trained on national data and peer-reviewed publications that have identified fraud, and it will then be tasked with finding similar patterns in Louisiana’s Medicaid data, Kolluru said. Staff within the Louisiana Department of Health will verify any findings, he added.
Maranto said the department will also be working with the state Office of Motor Vehicles to check if any Medicaid recipients have active drivers licenses in other states, which could help them determine their eligibility to receive Medicaid benefits in Louisiana.
ULL’s work on the AI program will not cost the health department because it already contracts with the university for other computing projects, Kolluru said.
ULL will also partner with the state Office of Technology Services to “modernize Louisiana Medicaid systems,” Kolluru said.
In addition to detailing the counterfraud measures, Greenstein said the state has set a goal to reduce drug overdose deaths during pregnancy by 80% over the next three years.
Overdose deaths have been the leading cause of maternal mortality in Louisiana since 2018, LDH Deputy Secretary Dr. Pete Croughan said.
The new initiative, Project MOM (Maternal Overdose Mortality) will push to increase the availability of naloxone and buprenorphine, medications that can halt the effects of opioid overdoses when administered promptly. Other goals include more training health care providers on opioid use disorders and using money from settlements with opioid manufacturers to expand residential treatment facilities and outpatient clinics.
According to publicly available data, there were 28 overdoses during pregnancy in 2020, the most recent year data in available. LDH is setting a goal to reduce overdose pregnancy deaths in the state by 80% over three years, reducing the death rate to five or six people annually. The department expects to appoint a Project MOM director within 90 days.
Greenstein also announced the state would be moving away from having a single pharmacy benefit manager (PBM) for its Medicaid program. Such entities have been labeled as “middlemen” that process prescription drug claims for the managed care organizations that provide Medicaid services, with critics saying they don’t provide enough transparency to determine whether they provide any cost savings to patients.
Since October 2021, Louisiana has worked with Magellan Medicaid Administration as its sole prescription benefit manager. On Monday, Maranto said the department would work closely with its managed care organizations who run the state’s Medicaid program and pharmacies to “ensure the best approach to managing these benefits.”
The continued closures of chain and independent pharmacies threatens patient access to critical prescription drugs across Louisiana, Maranto added. The state’s new approach will lean on the private contractors for Medicaid to handle prescription claims while also keeping drug prices in check.
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