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State: NC Governor Initiates Medicaid Fraud, Abuse Campaign

by Astrid Fiano, DOTmed News Writer | June 23, 2010
This report originally appeared in the May 2010 issue of DOTmed Business News

North Carolina Gov. Bev Perdue has announced that measures are being introduced into the state to combat Medicaid fraud, waste and abuse, which she says costs taxpayers millions of dollars each year. In addition, the governor has called for doubling the size of the state attorney general's Medicaid investigations unit.

The steps will include more vigorous investigation and prosecution of potential abusers, a Medicaid SWAT team, better use of technology to detect and prevent abuse, and an intensive public campaign to encourage reporting of suspected abuse. The new technology includes a software system that will analyze thousands of Medicaid claims and flag suspicious cases. Upon identification, the worst cases involving providers or consumers will be investigated by the Medicaid SWAT personnel.

"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 in a statement. She also wants tougher anti-fraud laws for the states including prohibition of kickbacks to providers who refer patients for Medicaid services and soliciting patients for unneeded services.