March 30, 2026 · HHS OIG
Louisiana Healthcare Connections Generally Complied With Federal and State Process Requirements When Denying Prior Authorization Requests
Issued on 03/30/2026 | Posted on 04/03/2026 | Report number: A-06-24-02000
Report Materials
Why OIG Did This Audit
- OIG has identified longstanding challenges, including limited oversight and access to specialists, thatmay reduce the quality of behavioral health care services provided to Medicaid enrollees.
- We audited Louisiana Healthcare Connections (LHCC), a Louisiana Medicaid managed care organization(MCO), because it had the highest number of denied service requests of any MCO in Louisiana.
- This audit, part of a series of reports examining Medicaid MCO service denials, assessed whether LHCCcomplied with Federal and State requirements when it denied requested behavioral health servicesthat required a prior authorization.
Results of Audit
LHCC complied with Federal and State requirements when it denied 64 of the 76 sampled behavioral health service requests that required a prior authorization. However, the remaining 12 denied service requests did not meet the administrative or procedural requirements. Specifically, LHCC did not:
- Provide written notices of adverse determinations (11 prior authorization denials)
- Provide written notice of adverse determination within the specified timeframe (1 prior authorization denial)
Based on the sample results, we estimated that 3,209 prior authorization denials for behavioral health service requests during our audit period (15.8 percent) did not comply with Federal and State requirements.
What OIG Recommends
This report does not contain recommendations.
Report Type
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Managed Care
Target Groups
–
Financial Groups
Medicaid
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.
This article was originally published on HHS OIG.
