(The Center Square) — The Louisiana Department of Health continues to struggle with a range of persistent financial and compliance issues, according to a new report released by the Louisiana Legislative Auditor.

Despite some progress, the agency has failed to resolve the majority of its prior audit findings — some of which have gone uncorrected for as long as seven years.

The audit, which reviewed the status of problems flagged in a March 2024 management letter, found that LDH had resolved only one issue: inadequate controls over and noncompliance with National Correct Coding Initiative requirements.

The remaining concerns — ranging from financial misreporting to Medicaid eligibility and provider oversight — remain unresolved and, in some cases, have worsened.

Among the most significant issues: LDH could not provide documentation to show that $248 million in Medicaid expenditures reported to the federal government had a matching state share as required. That shortfall led auditors to identify $168 million in federal questioned costs.

Additionally, the department failed to properly update federal cost-share percentages in state accounting systems for half the fiscal year ending June 30, 2024 — resulting in another $87.6 million in questioned federal costs.

In response, LDH management admitted the reporting errors and attributed the failures to staffing shortages and insufficient training.

The department said it has hired a vendor to provide support and training for federal reporting requirements and has launched a broader staff development plan aimed at improving accuracy and compliance.

Other key findings include:

• For the seventh straight year, LDH failed to fully enroll and screen all Medicaid managed care and dental providers as required by federal law, leaving gaps in the accuracy and reliability of provider information.

• For the fourth consecutive year, the department lacked adequate financial controls and submitted inaccurate federal schedules used to track expenditures of federal awards.

• Payroll certification failures also persisted for a third year, with auditors finding LDH had not followed procedures for timesheet approvals or leave requests.

• Disproportionate Share Hospital payments exceeded the federally-allocated limit by $4.2 million due to inadequate reconciliation.

• Maternity kick payments — lump sum payments made to managed care organizations when a member becomes pregnant—remained noncompliant for the second straight year, increasing the risk of overpayments.

• Eligibility determinations for Medicaid and the Children’s Health Insurance Program remained plagued by internal control issues for the fifth year in a row.

• Billing problems in behavioral health services continued into a sixth year, with auditors citing ongoing failures by LDH and its contractors, including Magellan Health Services, to prevent and detect improper claims.

• Home and community-based services under the state’s Medicaid waiver programs were also paid without adequate documentation for the second year in a row.