Audit: NC received $835M in Medicaid overpayments

Although a recent North Carolina audit found the state overpaid $835 million to Medicaid providers in 2015, the North Carolina Department of Health and Human Services disagrees, according to an audit report released Monday.

For the fiscal year that ended June 30, 2015, auditors found errors in 50 of 369 payments scrutinized, resulting in $4,288 in overpayments for services rendered to Medicaid patients. When state auditors extrapolated their findings across the total caseload of 127 million Medicaid claims processed for the year, they estimated overpayments at around $835 million.

State auditor Beth Wood described the sample projection as a way to "start showing the true impact of any of the errors that we find for all the programs that we've audited," according to The Robesonian

Overpayment errors occurred in part because of insufficient paperwork to prove services happened, ineligible medical providers submitting Medicaid reimbursement requests and payment rate mistakes, according to the report.

North Carolina's Department of Health and Human Resources has contested the audit findings. Spokeswoman Kendra Gerlach said the overpayment amount was lower, according to the report. The department, which only agreed with the errors cited in 31 of the claims the auditors examined, recalculated the overpayment amount and found it was closer to $690 million.

NC DDHS said it is continuously working to better its operational performance. This includes implementing an automated process to remove providers who have lost their licenses from the payment system, as auditors found 12 percent of a sample of 117 providers had suspended, surrendered or revoked licenses. 

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