State lawmakers are calling for stronger efforts to investigate fraud and abuse in North Carolina's Medicaid system. A state House committee held a nearly three-hour hearing Thursday on the topic, questioning Attorney General Jeff Jackson and Health and Human Services Secretary Dev Sangvai.
Rep. Grant Campbell, R-Cabarrus, says his staff found several examples of suspicious billing from Medicaid providers. One appeared to be headquartered in an abandoned storefront, and another reported high travel expenses and cash withdrawals.
"Rooting out waste, fraud and abuse isn't just a fiscal issue, it is a moral one," Campbell said. "Every dollar misused is a dollar not spent on a child with autism, a senior needing care or a patient waiting for treatment. ... We keep talking about how we have no money to look into this, and we had two staffers with Google and an Excel sheet in less than two hours came up with these figures, these filings and these locations."
Sangvai said he was not familiar with the providers named in Campbell's examples. Jackson says the examples Campbell cited wouldn't necessarily merit criminal charges.
"I think you just made an excellent case for why we should double down on data mining, because while all of that was compelling, none of it survives a grand jury," Jackson told the committee. "None of it is sufficient."
He asked the legislature to fund a new data mining specialist in his agency who could use artificial intelligence tools to find possible fraud.
"I'm asking you for one position because I'm very confident that with that position, I can come back to you in a year and show you a solid return on investment," Jackson said. "I want to get more aggressive in going after Medicaid provider fraud. This is the most cost-effective way."
Rep. Tim Reeder, R-Pitt, said Thursday's hearing was prompted by reports of Medicaid fraud in other states. "We've seen what's happened in other states, Minnesota and California, where there's been tremendous fraud with millions and billions of dollars," Reeder said, adding that he wants "assurances that North Carolina is not going to find ourselves in that same boat."
But House Democratic Leader Robert Reives noted that the legislature voted several years ago to cut staffing from the attorney general's office, leaving it with fewer resources to go after fraud.
"I would advocate that if we're serious about this, that we provide resources, because to this day, we have not been able to legislate more hours in a day," Reives said. "And if you don't have enough staff, and you don't have enough resources, and you don't have enough systems and software and upgrades, then you're behind folks who may defraud the system."
Fraud isn't the only concern for the Medicaid program. Sangvai told lawmakers the program will run out of money in May if the legislature doesn't allocate $319 million soon.
