Excerpt from: Star News (click for full article)
A North Carolina-wide crackdown on fraud has been intensified in recent months as state regulators took action against dozens of health care providers suspected of bilking the state's Medicaid program, including one in Wilmington, officials said.
Beginning in May, the N.C. Department of Health and Human Services started suspending Medicaid payments to certain outpatient behavioral health providers and placing 37 on prepayment review, a status where regulators scrutinize every incoming claim before approving reimbursement, said DHHS spokeswoman Chrissy Pearson.
Medicaid is a safety net for millions of lower-income Americans, particularly during a recession. But the inability of states to properly oversee the program has opened the door to abuse, with providers double-billing, submitted claims for services never rendered or, in some cases, billing for more hours than exist in a day. Such fraud drives up health care costs for every one and swindles taxpayers out of untold sums every year, experts say.
Recently heightened scrutiny already helped save the state millions of dollars. In the six months prior to being placed on prepayment review, those 37 providers collectively billed the state for $19.2 million in medical services. In the six months after regulators increased oversight, that group's total claim amounts plunged to just $138,000, a 99 percent reduction.
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