Potential Medicare fraud in Louisiana is pending a U.S. Supreme Court review

LAFAYETTE — The United States Supreme Court could soon hear a Louisiana lawsuit that alleges Medicare fraud by University Hospitals and Clinics, recent court filings show. 

The lawsuit raises questions about public-private partnerships in Louisiana, especially regarding the use of Medicare funds for private hospitals.

Use of Medicare Number

At the core of the suit is whether University Hospitals and Clinics, a teaching hospital under the LSU System and managed by Lafayette General Medical Center and Lafayette General Health, should have used a Medicare number intended for University Medical Center. UMC is a former state owned entity that UHC now operates.
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The Medicare Number verifies that a provider has been Medicare certified and establishes the type of care the provider can perform. In order to be a Medicare provider, certain criteria must be met. It’s unclear if UHC has met these qualifications. 

A public records request does show that UHC is continuing to use UMC’s Medicare number, potentially allowing them to collect public funds for private use.

With this potential violation addressed, the state is at risk of losing Medicare and Medicaid funding from the federal government, and taxpayers could be the hook to pay a huge settlement.

Previous discussions with CMS

In 2015, the Louisiana Department of Health and Hospitals and the LSU Board of Supervisors fought The Centers for Medicare & Medicaid Services, a federal agency that administers the Medicare program, to allow Medicaid funds be used by privately-owned hospitals. CMS mandated the state pay back $189,999,295 due to Louisiana’s “collection of impermissible provider-related donations”.  Part of the dispute and settlement following CMS’s 2015 ruling involves the state converting its charity hospital system to a series of public-private partnerships during the Bobby Jindal administration.

Although CMS approved the State Plan Amendments needed for the privatization plan, it rejected the financing component of more than $189 million that had already been collected. Rather than repaying the money in dispute, the state appealed.

Accountability

Under the Louisiana Department of Justice, the Medicaid Fraud Unit is tasked with uncovering potential medicaid fraud. The Louisiana DOJ is run by the State Attorney General, who is helping defend this lawsuit. CMS explains that Medicaid Fraud can be a solo endeavor or done by an institution/group.

The docket in this case is extensive due to the complexity of the private-public partnerships. Counsel for the resident behind the suit, Christine Mire, brought up these questions about Medicare funding. The defendants never responded to her arguments, and waived their response to the Supreme Court application. There have been numerous sanctions filed against Mire despite the merits of the case never being heard. 

The alleged Medicare fraud is an ongoing story. The case is being reviewed by the United States Supreme. UWK will provide updates as we receive them.

Download the Unfiltered with Kiran app from the Apple App Store and Google Play to stay updated on any new developments.

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