Civitas Review

The NC Medicaid Fraud Debacle Costs Taxpayers Millions


We all know that millions of dollars are wasted in state government every year (don’t get me started on waste at the federal level). This is a frustrating fact mainly because it is our tax dollars that are being misused. So much waste and fraud have come to exist that when news of a new story involving government waste and fraud arises, it usually doesn’t faze us.

Well, a recent revelation in North Carolina’s Medicaid program should cause indignation in all citizens of North Carolina, not just conservatives.

Thanks to IBM, $191 million dollars of potential fraudulent Medicaid claims have been exposed. That’s a lot of money; money, it should be remembered, that comes from taxpayers. I am sure that $191 million could have been put to use in the government, or, better yet, used by individuals to purchase goods and services or to create jobs. But, no, that money went down the drain, funneled to greedy and deceptive individuals.

Medicaid is not going anywhere anytime soon; therefore, it makes absolute sense that we use the tools created by IBM and other companies to crack down on the fraud that exists in government.

It has been reported that 206 outpatient behavioral health providers in North Carolina were the perpetrators of the $191 million dollars’ worth of fraud. Fraud was committed in a few ways: when providers billed for more than 24 hours of service rendered per day, when providers  intentionally overbilled for a service rendered, and when they double-billed (billed for a patient enrolled in group therapy and then billed for that same patient in individual therapy sessions). This obviously was a lucrative business for many duplicitous schemers. Fortunately, the software created by IBM was designed to identify the suspicious claims submitted to Medicaid. Hopefully, justice will soon be served to those who defrauded taxpayers of millions of dollars.

This event should be a wake-up call for North Carolinians. Medicaid is a billion dollar industry, and it appeared to be far too easy for some shady characters to funnel millions of taxpayer dollars to their own greedy pockets.

If fraud of this magnitude exists in Medicaid, I am sure it exists elsewhere in state government. North Carolina is struggling right now. It is time for the state to increase its efforts in finding and exposing fraud wherever it exists. The tools exist; it is simply a matter of mustering inner fortitude to utilize them for the sake of taxpayers across the state.

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