Saturday, April 17, 2010

North Carolina Medicaid Swat Team

Governor Beverly Perdue of North Carolina has teamed up with her Attorney General to create a Medicaid Swat Team.

North Carolina began the creation of this action by including TRICARE in an investigation of child welfare fraud. This, still to this day, is the only instance where child welfare fraud was examined from the direction of military health care.

I can only speculate (until I call the Attorney General) that is this Medicaid Swat Team is a product of the Medicaid Fraud Control Unit.

Since North Carolina is being such a progressive state in attacking Medicaid fraud (unlike Michigan), I am willing to put some money down that the state will develop the very first model to approach child welfare fraud from inside the structures of government. (I have the other models.)

All I can say is, thank you Governor Perdue, but I am still in love with Roy Cooper.

Gov. Perdue Kicks Off Campaign to Crack Down on Medicaid Fraud, Waste and Abuse

Posted on April 14, 2010. Filed under: North Carolina Medicaid | Tags: Medical practice insurance audit, NC Medicaid, NC Medicaid Audits, NC Medicaid MIC, North Carolina Medicaid Integrity Contractor |

Gov. Bev Perdue today announced a series of aggressive measures to set government straight by cracking down on Medicaid fraud, waste and abuse that costs taxpayers millions of dollars each year. The steps include stronger investigation and prosecution of potential abusers, including new Medicaid SWAT teams, better use of technology to detect and prevent abuse, and a campaign to encourage the public and providers to report suspected abuse.

“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,” said Perdue. “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.”

A new software system in DHHS will bring the detection of potential Medicaid fraud into the 21st century, by quickly analyzing thousands of Medicaid claims and flagging suspicious cases. Once identified, the most egregious cases will go to newly created Medicaid SWAT teams, specially trained investigators who will quickly deploy to investigate providers or consumers identified as potential abusers of the system.

Gov. Perdue also called for toughening North Carolina’s anti-fraud laws by stopping kickbacks to providers that refer patients for Medicaid services and ending the practice of soliciting patients for services they don’t need.

Gov. Perdue announced these new initiatives at a press conference at Rex Hospital in Raleigh. She also called for doubling the staff size of the Attorney General’s Medicaid Investigations Unit and an aggressive awareness campaign to encourage individuals and providers to report Medicaid fraud, waste and abuse when they suspect it.

“Medicaid fraud hurts our state’s most vulnerable residents and robs taxpayers,” said Attorney General Roy Cooper, whose Medicaid Investigations Unit handles criminal and civil cases. “Adding more investigators and ways to detect fraud is the right direction to go to stop those who abuse the system.”

The Attorney General’s 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. Proceeds from civil settlements typically reimburse Medicaid and penalties go to North Carolina public schools. Last year, the unit recovered $52 million, with a 10-year total of more than $300 million recovered.
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