What is of great interest to me in this particular article is the warm relationship between the the N.C. Department of Health and Human Services and the state's Medicaid Fraud Control Unit.
What I see is a partnership, far beyond a funded, mandated Medicaid Integrity Program. I see referrals. I see communication. I see partnership in accountability and transparency. I see innovation. I see program improvement, increased efficiency and improved delivery of services. I see reduction in health care costs. I see Electronic Health Records and functional information technology infrastructure of the state.
What I do not see is any of what I have just mentioned in the State of Michigan. Michigan is so bad with Medicaid fraud it had to have DOJ/HHS HEAT Task Force come in and set up shop. Detroit was one of 5 cities picked to set up shop because the Attorney General, Mike Cox, was too busy having fun. Still, nothing has changed except Attorney Generals.
Mr. Schuette, I am so disappointed with you. We shall do lunch, soon.
DHHS investigating dozens of alleged billing fraud cases
The N.C. Department of Health and Human Services has investigated 75 cases for potential Medicaid billing fraud and has already referred 35 cases to the N.C. Attorney General’s office.
Using data analytics software from IBM, DHHS combed through 75 cases that showed what it called “questionable billing practices by Medicaid outpatient behavioral health providers.” Of those, 35 cases totaling $21 million were referred to the special Medicaid Investigations Unit of the Attorney General’s office.
The practices were not listed by name, though 13 were in Wake County and four were in Durham County. DHHS spokeswoman Chrissy Pearson said the names of the practices were confidential because they have been referred for a criminal investigation. If charges are filed, the names of those being investigated would then be public record.
More referrals could be forthcoming if DHHS finds more suspicious billings.
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1 comment:
Can you list the questionable billing practices, explain your confidence in their warm relationship, innovation, and increased efficiency and improved delivery of services?
Thanks Beverly.
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