Louisiana's Health Department Misstated $304 Million — Again

For the fifth consecutive year, the Louisiana Legislative Auditor found⧉ that the Louisiana Department of Health (LDH) "did not have adequate controls over financial reporting to ensure financial reports were accurate."▸ The department's Annual Fiscal Report (AFR) for Medical Vendor Payments -- the state's Medicaid book of record, filed each year with the Division of Administration -- carried errors on both sides of the ledger: $145.0 million understated across two payable-account lines, a $30.1 million overstatement in a third, and another $129.2 million wrong on the receivable side. Add it up under the AFR's full-accrual basis and the auditor's FY2025 Single Audit Report identifies $304.3 million in misstated dollar figures LDH's own review process didn't catch.

The finding's condition section⧉ breaks the errors into two notes LDH files alongside the AFR.▸ In the Accounts Payable Adjustments note, Due to Medical Claims was understated by $33.5 million and Due to Audit Payables -- the largest single error in the finding -- was understated by $111.5 million, while Due to the Federal Government was overstated by $30.1 million in the opposite direction. In the Accounts Receivable Adjustments note, Due from the Federal Government was understated by $96.5 million and Due from Medical Providers was overstated by $32.7 million. None of these are small rounding errors on a small budget line; each is a distinct, named line item the auditor traced back to LDH's own submitted figures.

The AFR reports figures under two accounting bases⧉, and the auditor's finding shows they don't agree even with each other.▸ The Due to Audit Payables understatement is $111.5 million under full accrual but $105.5 million under modified accrual -- a $6.0 million gap between two supposedly parallel views of the identical line item. It's a small detail with a large implication: LDH did not have a single reconciled, correct figure available under either accounting basis before the report went out the door.

LDH's own written response⧉, filed under Appendix B of the audit, "partially concurs with the finding and recommendations" and does not dispute a single dollar figure in it.▸ But the department pushed back on one thing: it "does not concur with this being the fifth consecutive year for this finding," arguing that "the specific causes and adjustments identified during the FY 2025 review differ from those noted in prior audits." The auditor didn't let that stand. Its additional comments note that the AFR "has required multiple adjustments to both the Accounts Payable Adjustments note and the Accounts Receivable Adjustments note for each year beginning fiscal year 2021 through fiscal year 2025" and concludes flatly: "we consider this to be the fifth consecutive year for which the condition of the finding has occurred." The audit's own Summary Schedule of Prior Audit Findings backs the auditor's count, listing the identical finding title against LDH for fiscal years 2021 through 2024 in an unbroken line.

LDH isn't just repeating this one finding -- it's carrying more of the state's chronic problems than nearly any other agency.▸ The FY2025 Single Audit Report tallies 25 findings across 7 Louisiana state entities, of which 9 (36%) are repeat findings from prior audits. LDH alone accounts for 9 of those 25 findings -- tied with the Department of Children and Family Services for the most of any single entity -- and $2,879,053 in federal questioned costs, the largest dollar total of any entity in the report. And 5 of LDH's own 9 findings are repeats, meaning LDH alone holds 55.6% of every repeat finding statewide. (Only this one, 2025-001, is a financial-statement finding on LDH's own books; the department's other four repeat findings involve separate federal-award compliance issues not covered in this piece.) The pattern extends beyond LDH's own paperwork: the same audit found a statewide material weakness in internal control over financial reporting, and issued qualified compliance opinions for several of the state's largest federal programs, including the Medicaid Cluster -- the same program whose vendor-payment figures LDH's AFR misreports.