Louisiana Medicaid: They Knew. They Were Told. It Kept Happening.

Over the past few weeks, Minnesota has found itself in the headlines amid allegations that Medicaid programs were exploited on a massive scale. Whether those allegations ultimately lead to prosecutions or political fallout remains to be seen. Still, that’s Minnesota, and there’s not much we can do about it.

However, we’ve been following this issue right here in the Pelican State, and can assure you that Louisiana has its own substantial Medicaid problem. Unlike the stories dominating cable news, Louisiana’s concerns don’t depend on whistleblowers, leaked documents, or competing political narratives. They appear in black-and-white audit reports issued by the state’s own legislative auditor.

Those reports tell a troubling story: state officials were warned about improper Medicaid payments, given recommendations to address them, and then allowed the same problems to continue. Last year, we reported that more than $103 million in Medicaid payments went to people who didn’t even live in Louisiana. It wasn’t hidden, it wasn’t complicated, and it certainly wasn’t new. Auditors had already flagged it and provided a simple fix: use available data, verify residency, stop the bleeding.

As expected, the Louisiana Department of Health delayed, deflected, and promised to “do better next time.” Then, the auditors checked again. And, as it turns out, promises are considerably easier to make than reforms.

The Illusion of Correction

During the 2014 Regular Legislative Session, Act 461 was passed, requiring the Legislative Auditor to issue quarterly and annual audit reports and findings. These reports are required when the dollar impact is at least $150,000.00 relative to waste or inefficiencies, erroneous or improper payments, theft of money, and misappropriation of funds. The latest report from the Louisiana Legislative Auditor — issued in accordance with Act 461 for the Third Quarter, Fiscal Year 2026 — doesn’t tell a story of reform.

Instead, it tells the familiar story of repeated failure. To be clear, it’s not just one issue or one oversight. It’s years of them.

• For five consecutive years, auditors found financial reporting failures.
• For six consecutive years, auditors found failures in Medicaid eligibility controls.
• For seven consecutive years, auditors found inadequate behavioral health billing controls.

Seven years.

At that point, can we still blame it on a simple mistake? Or has it crossed into something else?

Same Problem, Bigger Pattern

Last year’s $103 million Medicaid issue wasn’t an anomaly but another symptom. This year’s report shows:

• $15.8 million in improper Medicaid behavioral health billing controls
• $23.5 million in federal grant subawards were not properly reported
• $2.1 million in federal questioned costs from exceeding funding limits
• Financial reporting errors requiring corrections between $30 million and $111 million

And that’s just what auditors documented. For yet another consecutive year, this isn’t a small leak.

What “Repeat Finding” Really Means

The phrase appears repeatedly in the report: “Repeat.” That’s not just an audit term—it’s an admission. It means the problem was identified previously, the agency was told, and still, the agency did not fix it. And the consequences? None that matters. Because if there were consequences, it wouldn’t still be happening six and seven years later.

If a private company reported financials off by tens of millions of dollars five years in a row, regulators would step in. If an insurer paid claims for people who weren’t eligible year after year, executives would be gone. But this is the government. So instead, the failures are documented… filed into a drawer… and repeated.

The Consequence No One Talks About

Last year, we asked how $103 million could be wasted on people who don’t live here. This year, the better question is: How much more hasn’t been caught yet?

Because when the same findings repeat for seven years, you’re not looking at isolated incidents. You’re looking at a system that doesn’t detect problems quickly, doesn’t correct them when found, and doesn’t face consequences when it fails.

At the same time these failures continue, Louisiana taxpayers are told there’s a “fiscal cliff,” revenue is tight, and services are at risk. And the solution? Higher taxes. Broader taxes. More taxes. Because the problem, apparently, isn’t how money is handled — It’s that you’re not sending enough to cover for the theft occurring under the watch of those we voted into office.

The Bottom Line

Last year was $103 million. This year’s report is full of repeated failures, millions in questioned costs, and controls that still don’t work. Nothing was hidden, misunderstood, or fixed. So we’re left exactly where we started. With the government asking for more money, while proving, year after year, it can’t manage what it already has.

Over the past few weeks, many Americans have been watching Minnesota and wondering whether anyone is paying attention. Here in Louisiana, the evidence has been sitting in public audit reports for years. We’ve been reading them. We’ve been reporting on them. The more troubling question is whether anyone in state government is listening.

Well, if anything, I suppose we could applaud their consistency.

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