State DHHS errors result in $100M+ in wrongful payments to providers, ineligible recipients

Errors by the state department that oversees the Government Health Care Program for needy families resulted in wrongful payments totaling more than $100 million. That's only for the 2018 budget year.

When reviewing the Medicaid program, the state auditor found North Carolina's Department of Health and Human Services overpaid medical providers $71.7 million and paid more than $29 million to people who weren't even eligible.

[LINK: State Auditor Report]

“Anytime we can find any evidence of overpayments to providers or any other kind of waste -- or fraud or abuse in a public program like this -- it’s an important victory for taxpayers,” said Rob Schofield, the North Carolina Policy Watch director.

According to the auditor's report, the massive errors "could have been used to provide additional services to other eligible beneficiaries or reduce overall program costs."

For overpayments to providers, DHHS leaders blamed clerical errors and inadequate documentation kept by health care providers.

The auditor wants department leaders to analyze each error and try to recoup the government money that was overpaid.

The auditor also noted in the report that DHHS "did not adequately monitor the work of some of its contractors that help ensure Medicaid services are medically necessary and payments are not fraudulent."

[House Republicans pitching Medicaid expansion in NC again]

“It needs to be watched very closely at all times. This is always the case with public programs that have private vendors involved,” Schofield said.

Lawmakers have approved better standards to monitor quality in recent years, but the state auditor has found some of the same issues year after year.

DHHS Statement:

"Please be aware the figures cited in the audit are not actual dollars but were calculated by applying the error rate to the total budget for those payments. The actual overpayments identified by the audit were approximately $14,000."

Cox Media Group