Protecting Taxpayer Dollars
Fraud, waste, and abuse cost taxpayers billions annually. Protecting Medicaid means protecting the taxpayers who fund it and the families who depend on it.
Louisiana Healthcare Connections leads the fight against fraud, waste, and abuse in Medicaid. Through advanced data analytics, proactive oversight, and coordinated investigations, we help ensure taxpayer dollars are used responsibly and healthcare resources reach the people who need them most.
The Managed Care Difference
Managed care introduces stronger oversight, accountability, and data monitoring that helps identify irregular billing patterns and prevent improper payments before they occur.
$1.15B
Estimated improper payments prevented in Louisiana every year by choosing managed care over fee-for-service, based on CMS’s own Payment Error Rate Measurement data.
Previous Model: Fee-for-Service
12.8%
Improper payment rate under the previous Medicaid model
Current Model: Managed Care
0.05%
Improper payment rate under the managed care model
Oversight and Accountability in Medicaid Spending
In Louisiana, $9 billion in Medicaid spending is administered through managed care organizations.
Louisiana Healthcare Connections deploys Healthcare Fraud Shield™, an industry-leading analytics platform capable of reviewing large volumes of billing and claims data to detect early indicators of fraud, waste, and abuse before payments are made.
We also work closely with state partners to maintain strong program oversight. Louisiana Healthcare Connections participates in regular Program Integrity coordination calls with the Louisiana Department of Health and submits TIPS reports to support state investigations and enforcement actions.
1.3 Million
Potential waste, abuse, fraud, or improper payments prevented in one year through automated claim safeguards.
“Every dollar lost to fraud is a dollar taken away from patient care. Protecting the integrity of Medicaid is not optional, it’s our responsibility. Through advanced data analytics and strong partnership with the state, we work every day to safeguard taxpayer dollars and ensure healthcare resources reach the Louisiana families who depend on them.”
— Jamie Schlottman, CEO, Louisiana Healthcare Connections
Understanding the Problem
What Is Fraud, Waste & Abuse?
F
Fraud
Deliberate deception involving the knowing submission of false claims or misrepresentation of facts to obtain healthcare payments that would not otherwise be authorized. Fraud is a criminal act under federal law (18 U.S.C. § 1347).
W
Waste
Overutilization of services or other practices that directly or indirectly result in unnecessary costs to the healthcare system. Waste typically does not involve criminal intent but represents misuse of healthcare resources.
A
Abuse
Practices that result in payments for items or services when there is no legal obligation to pay, including services that are not medically necessary or fail to meet professionally recognized standards of care.
Source
- CMS Payment Error Rate Measurement Program, Rolling National Medicaid Improper Payment Rates, average of 2019-2023 rates.