- Associated Press - Monday, April 4, 2016

RALEIGH, N.C. (AP) - North Carolina’s Medicaid program is again mistakenly overpaying some doctors and hospitals, an annual compliance audit released Monday found. This time, state auditors disclosed a likely program-wide cost: $835 million.

The State Auditor’s Office, which must review how agencies spend federal money, has routinely reported on problems in Medicaid billing over the years. Officials usually have just provided what they uncovered in a sample of provider payments, however, because that’s only what the federal government required.

In this audit, covering the year ending June 30, 2015, auditors found errors in 50 of 396 payments scrutinized, with $4,288 in overpayments.

With Medicaid making 127 million payments costing $11 billion in state and federal dollars, using sample projections to publicly assign an overpayment amount to the entire Medicaid population should be helpful to state policymakers, State Auditor Beth Wood said. Medicaid is one of North Carolina government’s largest programs and until recently had a history of shortfalls.

Similar monetary projections are being offered for the first time in this year’s round of federal compliance audits across state government, according to the auditor. Wood said there was previously pushback from state agencies to insert such calculations into reports.

“We wanted to start showing the true impact of any of the errors that we find for all the programs that we’ve audited,” Wood said. The state’s share of the overpayments would be 35 percent, with the federal government paying for the rest.

Errors occurred in part because of insufficient paperwork to prove that services occurred, ineligible medical providers seeking to get paid and payment rate mistakes, the audit said.

In its written response within the audit, the Department of Health and Human Services, which oversees Medicaid, said only 31 of the 50 payments were actual errors, based on the state Medicaid agency’s independent review. Using its statistical sampling method, the department calculated the error at $690 million.

Later Monday, the department said in a statement that projecting the sample for a Medicaid-wide overpayment didn’t offer “a correct picture for North Carolina citizens. It is not accurate, nor reasonable to believe that North Carolina overpaid providers by this margin.”

The agency said it has made “significant progress” since 2013 improving operations, pointing to a sample in the previous year’s report showing a 24 percent error rate. Auditors calculated a 13 percent error rate in Monday’s report.

A Medicaid leader said the overpayments shouldn’t be equated with provider fraud but rather for things like incomplete documentation for completed medical care.

“It would not be fair to say that that money is there to go and recoup,” Dave Richard, the state’s Medicaid director, said in a phone interview Monday evening.

Still, DHHS said it was committed to correcting issues cited in the audit, which recommended the agency better educate providers about proper billing and to improve other procedures.

Monday’s report cited other issues, including duplicate payments to food stamp recipients, inaccurate performance reports on federal funds used for North Carolina’s welfare program and benefits to ineligible participants for an AIDS drug assistance program.


Copyright © 2018 The Washington Times, LLC.

The Washington Times Comment Policy

The Washington Times welcomes your comments on Spot.im, our third-party provider. Please read our Comment Policy before commenting.

 

Click to Read More and View Comments

Click to Hide