North Carolina's Medicaid agency launched its own 10-person unit to investigate fraud and abuse in the $2.3 billion program. The effort "will not duplicate any efforts under way" with the Medicaid Fraud Control Unit in the state attorney general's office, said Mark Benton, senior deputy director and chief operating officer at the state Division of Medical Assistance. "They're charged with prosecuting criminal acts of fraud and abuse and have higher evidentiary standards," Benton said. "But in the past, while we're waiting, those providers could continue to bill the program. Historically, we have not taken administrative actions against them, and we needed the teeth to do something in the interim." The unit, created out of existing staff from the division, will identify and then visit providers whose billings far exceed state averages, state Medicaid Director Allen Dobson said in a news release. Dobson said providers found by an administrative review to have committed fraud and abuse will see their Medicaid payments and enrollment eligibility suspended while criminal proceedings take place.
North Carolina is one of a number of states trying harder to crack down on Medicaid fraud as spending grows. Earlier this week, New York strengthened its Medicaid enforcement capabilities in both the state attorney general's office and state health department following a New York Times investigation that found extensive fraud in the program. -- by Mark Taylor