A financial audit reported (PDF) that North Carolina's Division of Medical Assistance had deficiencies in internal controls for three of the four vendor contracts that it has established to help fight Medicaid fraud.
N.C. audit finds fault with fraud controls
The division of Medical Assistance contracts with four vendors—Health Management System, IBM, SAS and Public Consulting Group—as part of its efforts to deal with Medicaid provider and beneficiary fraud, waste and abuse.
The audit, dated July 24, found deficiencies in internal control and instances of noncompliance.
It said the IBM, SAS and PCG contract had deficiencies in internal control. However, the state auditor noted in the report that the IBM and SAS contracts are considered a valuable or beneficial tool for the Division of Medical Assistance.
The audit said “recoupments identified by PCG have not proven to be reliable, so the actual benefit being derived from the contract is unclear.” It did not identify reportable deficiencies in internal control with the HMS contract.
For the IBM and SAS contracts, the state auditor recommended that the Division of Medical Assistance “evaluate payment methodologies before entering into contracts to ensure payments correspond to established contract deliverables.”
In addition, it recommended that the division develop and implement procedures that can evaluate the accuracy and effectiveness of the reviews conducted by PCG.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.