State News

Perdue begins Medicaid fraud, waste prevention effort

Posted March 24, 2010

— Gov. Beverly Perdue says it's time for North Carolina to enter the technological age when it comes to curbing fraud and abuse of the state's $10 billion Medicaid program.

Perdue announced on Wednesday the state's Medicaid office has started using a computer program designed to review Medicaid files to determine whether patients or physicians are gaming the system. The effort requires scanning untold pages of paper documents over the years.

A new "Medicaid SWAT team" of special investigators will review cases flagged by the computer software as suspicious.

“In these tough times, when Medicaid enrollment is growing even as we face deep budget shortfalls, we must do more to root out waste and crack down on folks who are abusing or defrauding Medicaid,” Perdue said in a statement. “Tens of millions of taxpayer dollars each year are wasted on Medicaid fraud, waste and abuse. It’s got to stop, and we will not allow it to continue.”

Health and Human Services Secretary Lanier Cansler said the effort won't require a large state investment since program provider IBM will get paid based on 10 percent of the money from the waste and fraud that is uncovered.

Perdue also called for toughening North Carolina’s anti-fraud laws by stopping kickbacks to providers who refer patients for Medicaid services and ending the practice of soliciting patients for services they don’t need. She also wants to double the staff of the Medicaid Investigations Unit in the Attorney General's Office and create an awareness campaign to encourage people and providers to report Medicaid fraud, waste and abuse when they suspect it.

The Medicaid Investigations Unit is composed of investigators, auditors, attorneys and State Bureau of Investigation agents who look into cases of fraud, abuse and neglect of residents in medical facilities that receive Medicaid funding. Last year, the unit recovered $52 million. Proceeds from civil settlements typically reimburse Medicaid, and penalties go to North Carolina public schools.

“Medicaid fraud hurts our state’s most vulnerable residents and robs taxpayers,” Attorney General Roy Cooper said in a statement. “Adding more investigators and ways to detect fraud is the right direction to go to stop those who abuse the system.”

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  • almagayle50 Mar 25, 11:47 a.m.

    She is only targeting medical care for fraud, while she and Easley have ignored for years the fraud that takes place in CAP/MR/DD services. The bill through agencies, case managers, and huge army of people who are supposed to assure the integrity of these payments commit huge dollars in medicaid fraud. When it's reported, rereported, documented, resent, resurrected for years on end, the end result is that the governor and her employees decline to correct it or punish it. In other words, the enable it to keep those federal dollars coming here.

  • mrbigt032j Mar 24, 7:44 p.m.

    give a drug test before you give anyone a medicade card or welfare check half would not get a check. you have to take a drug test for a lot of jobs

  • affirmativediversity Mar 24, 5:13 p.m.

    This is the FRAUD and waste that should be investigated...it doesn't take a genius to figure out who Bev Perdue works for...and its not the Taxpayers of NC!

    http://www.news-record.com/content/2008/10/31/article/perdue_mccrory_campaigning_hard_in_final_days

    http://www.capitol-monitor.org/non-profit-profiles/seancseiu-packs-political-powe.php

    http://www.campaignfreedom.org/blog/id.766/blog_detail.asp

    http://projects.newsobserver.com/tags/seiu?page=1

    http://www.seanc.org/search/?query=board%20members

    http://www.seanc.org/about/board.aspx

  • nighttrain2010 Mar 24, 4:31 p.m.

    jgriffith3792 it's not new technology, however Bev is caught. Roy Cooper, the partisan who apparently cares more about party than Constitutional principle, isn't going to join the other states and sue so Bev has to look like she's doing something to address the concerns of those of us who despise this latest government power grab.

    Of course it won't, and it doesn't, but it does two things. Bev looks like she's doing something (trolling for votes never ends you know) , and yet another person in this state (friend of the party in power) will get their pockets lined with taxpayer money when this 'program' is established to do nothing...

    And who says NC is corrupt?!?

  • DonJaime Mar 24, 4:23 p.m.

    Either they're so detached they have no clue how the system really works or this really is just to buy some time and save face. I feel sorry for the poor schmucks that have to scan thousands and thousands of pages of information -that's already electronically recorded to begin with-.

    If they wanted real results they'd have HP run reports already and would have the SBI knocking on doors.

  • jgriffith3792 Mar 24, 4:01 p.m.

    WOW. JUST WOW. How long has she been in office now?

    Insurance companies have been doing this for years - decade or so. And this is new technology to the state? Wow.

    Although I know, the worst is still ahead of us....

  • wildcat Mar 24, 3:51 p.m.

    Purdue main concern should be about getting jobs in NC. She should also pardon Taylor. Obviously she don't know how to put her priorities first.

  • Plenty Coups Mar 24, 3:47 p.m.

    "Well, providing job training (even teaching people skills and trades like they do at some jails)"

    All the teachers are laid off. Have to save money. See the WRAL article.

  • grimreaper Mar 24, 3:40 p.m.

    Bring in millions of dollars? Huh? You mean save millions don't you? Oh wait, you will spend twice as much as you save...right that is the big government doomsday plan.

  • Its My Prerogative Mar 24, 3:23 p.m.

    @ staceynipper

    I totally agree!!! Most (I didn't say ALL for you BASHERS out there) of the welfare recipients sit and home ALL day and smoke, drink, make more tax write offs (kids) and do whatever and wait for their hand-outs. They should be REQUIRED to pass RANDOM drug test to continue receiving their benefits. Then you have elderly people that need assistance and can't get it because its being sucked up by these goons!!!

    This program should have been implemented a LONG TIME AGO!!!!

    I have a family member that I call the so called "fraud" hotline on EVERY week. Do you think anything has come of it??? NOPE b/c she is still a KID VENDING MACHINE, smoking, drinking, not working, AND SELLING hundred of $$ in food stamps!!! Just plain old sickening!!!!!

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