N.C. Forms 10-Member Task Force to Target Medicaid Claim Abuses

Medicaid fraud consisting of financial abuses by doctors, providers and patients will be targeted by a new 10-member fraud unit being formed in North Carolina.

“We have to ensure that every Medicaid dollar is well spent,” Allen Dobson, a top assistant secretary in the Department of Health and Human Services, which oversees Medicaid told the Winston-Salem Journal. “The taxpayers of this state need to know that we are taking waste seriously.”

Medicaid is the government health insurance program for 1.5 million low-income children, elderly and the disabled in North Carolina. The state’s share of Medicaid spending totaled $2.3 billion last year.
Dobson said members of the new unit will look into fraud allegations, scrutinize billing records and make personal visits to providers whose numbers sound off-base.

“We will identify the outliers, providers whose numbers just don’t match what an average provider is doing across the state,” he Dobson said in a news release.

The state’s Medicaid division also will suspend Medicaid payments and enrollment to providers if an administrative review determines fraud has been committed that warrants a referral to the state Attorney General’s Office for possible criminal charges.

The division also will begin asking providers if they have been ever sued, sanctioned by another insurer or had actions taken against them by a license board. The questions are standards practice among private insurers and will improve patient care, according to Dobson.

Medicaid fraud prevention has been a major talking point among state Senate Republicans, who contend the state could ultimately gain hundreds of millions of dollars in savings.

State officials already are using a new computer program designed to look for unusual items or patterns in Medicaid data that could be markings of fraud.