Audit: DHHS ill-equipped to handle troubles with Medicaid billing system

Posted December 9, 2013

— The state Department of Health and Human Services doesn't have a plan to address the range of problems with its troubled Medicaid billing system, according to a state audit released Monday afternoon.

The NCTracks system has been under fire since it was launched in July. Health care providers have complained about difficulties submitting claims and tardy payments that some say have endangered the future of their businesses. Lawmakers have twice called DHHS Secretary Aldona Wos and other department officials to testify in recent months about what is being done to fix the problems.

State auditors documented more than 3,200 defects in the $484 million system and said the department "has an inadequate framework for the timely resolution" of the defects. Also, the state has no comprehensive plan to address the various issues providers and others have brought up.

The audit calls for establishing guidelines and a methodology for tracking the timely resolution of defects – 637 remain unresolved, almost three-fourths of which are labeled as "high" importance – and says DHHS officials should monitor vendor Computer Sciences Corp.'s performance against those metrics.

"Auditors found that NCTracks defects are being resolved, however, lack of formal goals to resolve defects in a timely manner indicates that the department and CSC may not be managing all NCTracks defects efficiently," the audit states.

For example, auditors found that DHHS managers gave conflicting answers when asked what was meant by the department establishing a "target response time frame" to handle defects within a certain time.

Fixing the defects has pushed all other upgrades to the back burner, auditors said, so 12 of 14 changes mandated by lawmakers or government regulations haven't been implemented. DHHS doesn't have a schedule for putting these upgrades in place or a cost estimate for making them, the audit notes.

DHHS should have an update to lawmakers by March 1, Wos said in her response to the audit.

She also said the rate of defects in NCTracks is much lower than the average software program, given the size and complexity of the system.

"Although NCTracks has fewer defects per function point than industry average for a comparable software system, we understand that some providers have not received payment for their claims for services. We have and will continue to work diligently to ensure that every provider is paid timely and accurately for covered services rendered," she wrote.

Wos disputed that DHHS has no plan for tracking problems with NCTracks and their resolution. "The department has been managing NCTracks defects efficiently since go-live. Formal target response times are in place and defect metrics have been tracked," she wrote.

Auditors said, however, that her response is "misleading," noting that DHHS has no documentation of how it has handled defects.

Bob Seligson, executive vice president and chief executive officer of the North Carolina Medical Society, said the audit "confirms our worst fears about NCTracks."

"This flawed system has been hurting patients and hurting doctors throughout the state since it went live on July 1," Seligson said in a statement. "We heard about the problems from our members then, and we continue to hear about them to this day. We hope definitive action will be taken now to fix NCTracks once and for all."

Wos didn't respond to the final finding in the audit, which recommends that lawmakers consider legislation addressing state employees who go to work for companies with state contracts that the employees helped manage.

Paul Guthery left DHHS in August and went to work for CSC. Guthery was considered a main point of contact with CSC while working for DHHS, as he was responsible for certifying NCTracks' testing process.

"The state government ‘revolving door’ creates a perception of bias or conflict of interest," the audit states.


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  • tllight Dec 19, 2013

    This state department is one of the biggest 'rat holes' in all of state government. Nothing short of changing the culture will help - but who will be the change agent for that? Seems DHHS has taken on a life of it's own!

  • jtd1969 Dec 10, 2013

    Based on the salaries report a month ago, isn't this department among the highest paid in the state? Why are they ill-equipped?? Taxpayers paying big money for nothing...

  • teddyspaghetti Dec 10, 2013

    I saw the same thing happen with the Medicaid billing 7-8 years ago when EDS and Computer Sciences were in a battle for who would process the claims.....except that Lanier Cansler (D) was the secretary and he lobbied and consulted for Computer Sciences (who got the contract!!) BTW, Mike Easley (D) was governor then.

    Neither the Rs nor the Ds have a monopoly on corruption!!!

    When will someone represent US - the taxpayers?????

  • whotmewory Dec 10, 2013

    Not just when is Wos leaving; when is McCrory leaving?

  • whotmewory Dec 10, 2013

    DHHS Secretary Aldona Wos is intentionally sacking the staffers of DHHS by a policy of inaction: frustrate the employees till they walk; then His Highness King McCrory can replace them with hires through the State's super cheapy Temporary Staffing entity that offers NO benefits whatsoever along with garbage wages (ergo no vacation time with loved ones - just work - every day; ergo no medical - what the heck, we gots Obamacare; and manadatory layoffs every 11 months to prevent this entity from ahving to put funds into the Employment Security insurance coffers). Such nice human morality for a state with more churches than gas stations.

  • uBnice Dec 10, 2013

    McCrory is on record as saying that Wos is brilliant. I fail to see anything brilliant that she has done or is doing.

    But then again, McCrory is an intellectual lightweight who is way over his head as governor.

  • HeadsUp Dec 10, 2013

    Keep in mind that McCrory and Wos chose to launch NC Tracks despite repeated warnings that it had not been tested adequately and might not work. That was irresponsible, if not reckless.

    They had better alternatives: delay it long enough to work out the problems if possible, or pull the plug and start over. They chose to do neither.

    Hold them accountable, taxpaying citizens.

  • ccsmith1902 Dec 10, 2013

    When is Wos leaving? DHHS needs competent leadership.

  • gingerlynn Dec 10, 2013

    I am sure it is the problem at NCFAST too! The main problem is they have NO EXPERIENCE with the business and don't understand how it is supposed to work! I have never seen so much rework in my 25 year career!

  • teddyspaghetti Dec 10, 2013

    Prozacdispenser and gingerlynn.....same thing is happening at the Dept of Revenue!!

    When will this state wake up and say "we will hire US/NC citizens first"? The consulting firm uses the cheapest labor they can find and we somehow expect a great product? Geesh!