Medicaid Mismanagement and Fears of Medicaid Fraud from N.C. State Auditor

Gov. Roy Cooper, in the wake of COVID-19, made it easier to apply for Medicaid. Carolina Journal’s Julie Havlak reports that N.C. State Auditor Beth Wood has concerns this may lead to Medicaid fraud. Havlak writes:

Cooper’s executive order authorized DHHS to temporarily waive any restrictions on self-attestation, other than making sure applicants meet citizenship or immigration requirements. The order will help DHHS handle an expected flood of new applications. But it also lets DHHS rely more on unreliable data, Wood said.

It will likely be difficult to determine who receiving benefits was eligible and who was not after the pandemic. As Havlak explains:

The program relies on applicants’ honesty to calculate if they’re eligible, and federal regulations prohibit Wood from checking that honesty.

“The most critical pieces that determine whether you’re eligible — income, dependents, age — I’m not able to verify that,” Wood said.

The Department of Health and Human Services ran into some issues recently that have brought into question the department’s management. Havlak writes:

Even before the outbreak, the N.C. Department of Health and Human Services struggled to maintain proper oversight. The department risked overpaying millions of dollars because it failed to oversee programs and contractors — including those responsible for health care, food benefits, opioid treatments, and family reunification, according to a recent audit report…

The recent audit report highlighted the absence of quality controls over the contractors that ensure Medicaid spending is medically necessary. Contractors oversee some $2.5 billion for services that require prior approval each year. Only one of the five contractors has written monitoring procedures.

Wood would like to see penalties increased for taking advantage of this public assistance program. Havlak quotes Wood:

“There should be severe consequences to take advantage of a program with limited money that was meant for people who really, really need it. It’s not a money tree. It can’t give forever. Eventually it will run out if people abuse it.”

Read the full story here. Read about Beth Wood’s audit of Rocky Mount here.