Legislators Discuss Medicaid Audits

Tuesday morning the Joint Legislative Oversight Committee on Health and Human Services met in Raleigh to receive updates from DHHS staff regarding legislation enacted earlier in 2012, including the requirement of a thorough audit of Medicaid in the coming year.

Much of the meeting’s discussion also centered around a secondary proposal by the Department of Health and Human Services to conduct an outside review of the Medicaid program on top of the audit enacted by legislators.  Department officials argue that an outside review could compliment a state audit and was not intended to delay or interfere with the work of the State Auditor’s office.  State Auditor Beth Wood has been tasked by the Legislature with reviewing Medicaid, its vendor contracts, financial controls and expense forecasting, with a final report due on February 1, 2013.

This week legislators also took a look at a previous audit of the program, performed by the State Auditor, which has revealed a number of problems in DHHS contracts for services to identify fraud, abuse and over payments in Medicaid. Some legislators have expressed concerns over the fact that these vendors receive contingency fees rather than a flat fee for their product. State Auditor Beth Wood has even cited one reported overpayment to a provider of $1.34 million which was later reviewed and reduced to only $22,093.  The initial RAC audit was performed by a firm paid based upon the number of fraudulent payments uncovered.

As legislators continue asking questions, the NCMS will play an active role in the conversation around Medicaid RAC audits, seeking real solutions and sharing the experiences of our members.

Visit the NC General Assembly website here to view all of the handouts from this week’s Health and Human Services Oversight Committee meeting.


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