Healthy Louisiana Administrative Actions, Monetary Penalties and Sanctions

Healthy Louisiana contractors must meet the requirements of their contract with DHH. If a contractor is deficient or non-compliant with contract requirements, LDH may apply administrative actions or assess monetary penalties to obtain the level of performance required for successful operation of the Healthy Louisiana program.

Administrative actions include:

  • A warning through written notice or consultation;
  • Education requirement regarding program policies and billing procedures; The contractor may be required by LDH to participate in a provider education program as a condition of continued participation. Contractor education programs may include a letter of warning or clarification on the use and format of provider manuals; instruction on the use of procedure codes; review of key provisions of the Medicaid Program; instruction on reimbursement rates; instructions on how to inquire about coding or billing problems; and quality/medical issues;
  • Review of prior authorization implementation processes;
  • Referral to the Louisiana Department of Insurance for investigation;
  • Referral for review by appropriate professional organizations;
  • Referral to the Office of the Attorney General for fraud investigation; and/or
  • Require submission of a corrective action plan.

Monetary penalties apply to specific failed deliverables, including:        

  • Operations Start Date
  • Operations Readiness
  • System Readiness Review
  • Encounter Data
  • Pharmacy Claims Data
  • Prompt Pay
  • Claims Summary Report
  • Quality Assessment and Performance Improvement Reports
  • Patient Center Medical Home Plan Reports
  • Member and/or Provider Satisfaction Report(s)
  • Member Services Activities
  • Member Call Center
  • Administrative Service
  • Provider Demographics
  • Provider Service Activities
  • Provider Call Center
  • Covered Services
  • Management Information System
  • Emergency Management Plan
  • Transfer of Data
  • Termination Transition Plan

Below are links to a report of administrative actions applied to and/or monetary penalties assessed against each Healthy Louisiana contractor, with links to supporting documentation.

Healthy Louisiana Contractors 2015-2018

Aetna Better Health
Amerigroup
AmeriHealth Caritas
Louisiana Healthcare Connections
Maximus
MCNA
United Healthcare Community Plan

 

 

 

 

 

 

 

 

Healthy Louisiana Contractors 2012-2015
Amerigroup
Community Health Solutions
AmeriHealth Caritas
Louisiana Healthcare Connections
United Healthcare Community Plan