Louisiana Healthcare Connections Prior Authorization Audit Findings

HHS OIG Reports & Publications

Published March 30th, 2026

Detected April 4th, 2026

Summary

HHS OIG completed an audit of Louisiana Healthcare Connections (LHCC), a Louisiana Medicaid managed care organization, examining 76 sampled behavioral health service denials requiring prior authorization. LHCC complied with Federal and State requirements for 64 of 76 sampled denials (84%), but 12 denials failed to meet administrative or procedural requirements, primarily missing written notices of adverse determination. OIG estimates 3,209 prior authorization denials (15.8%) during the audit period did not comply with requirements.

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What changed

HHS OIG audited Louisiana Healthcare Connections (LHCC), the Louisiana Medicaid managed care organization with the highest denied service requests in the State, focusing on behavioral health service denials requiring prior authorization. The audit found that LHCC complied with requirements for 64 of 76 sampled denials (84%); however, 11 denials lacked required written notices of adverse determination and 1 denial was not provided within the specified timeframe. OIG projects these deficiencies affected approximately 3,209 prior authorization denials (15.8% of the audit universe) during the audit period.

The report contains no recommendations and imposes no penalties. LHCC and other Medicaid MCOs should review their prior authorization denial notification processes to ensure written notices of adverse determination are issued for all denials and within required timeframes. CMS maintains oversight authority over Medicaid managed care organizations and may consider these findings when evaluating MCO performance.

What to do next

Review prior authorization denial notification processes to ensure written notices of adverse determination are issued for all denials
Verify that written notices of adverse determination are provided within required Federal and State timeframes
Implement quality controls to address the 15.8% estimated non-compliance rate identified in the audit findings

Source document (simplified)

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.