‘No excuses’ – NC’s Medicaid head says after audit details millions being misspent

North Carolina

RALEIGH, N.C. (WNCN) — In response to a recent audit that detailed millions of dollars in misspent money and potential risks to patients, the head of North Carolina’s Medicaid program said Tuesday there are “no excuses.”

As CBS 17 reported last week, the State Auditor found millions of dollars were given to non-qualified health care providers and there was “an increased risk that providers whose actions posed a threat to patient safety were enrolled in Medicaid.”

To view the audit report, click here.

The auditor said the North Carolina Department of Health and Human Services was not properly verifying whether providers, such as doctors, had lost their licenses or had them suspended.

The report identified $15 million in improper payments.

Medicaid is a $14 billion program that provides health coverage to just over two million people, many of whom are lower-income.

“We were relying upon an automated system that didn’t work, frankly. We have corrected that, and we’re doing a manual system to make sure we’re pulling from each one of those licensure boards,” said Dave Richard, deputy secretary for NC Medicaid.

DHHS was supposed to do use two so-called “web crawlers,” which would search for red flags about license issues, but Auditor Beth Wood said both programs failed to operate correctly and the agency never knew it.

“They didn’t test their system to find out it wasn’t working,” she said.

Wood’s team sampled 191 providers to check for themselves.

“Of the 191 we checked, 185 had not been recertified,” she said.

Richard told lawmakers Tuesday, “Our system did not catch, as we would like that to. We are in the process of making a system change to be able to connect those, and we’ll have that done in the next several months. I would anticipate no later than three months.”

Rep. Larry Potts (R-Davidson County) criticized the agency for “poor management.”

“When you have a report as damning as this is, usually people lose their jobs,” he said.

The audit called attention to 18 health care providers, who are not named, who were disciplined by their licensing boards for various issues, including sexual misconduct, substance abuse and fraud.

When Potts referenced that issue and asked DHHS Secretary Dr. Mandy Cohen if anyone would be fired over these issues, she said, “Those are providers. They do not work for DHHS.”

She added, “It’s important to understand that the audit did not find any issues related to the initial application. The audit was related to our ongoing monitoring.”

Wood said her team will go back in a year to see if the issues have been resolved.

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