State Auditor Releases Follow-Up Audit Revealing Continuing Problems With NC Medicaid System
Yesterday, North Carolina State Auditor Dave Boliek released a follow-up audit of the North Carolina Medicaid System. A 2021 audit found several issues, and the most recent report highlights several areas of concern. The audits focused on payments made to medical providers who had previously had their licenses revoked or services limited due to patient safety concerns. The most recent audit revealed that issues concerning patient safety were still continuing four years later.
“When you go to the doctor, you shouldn’t have to worry about whether your physician is in good standing with the professional medical community,” said State Auditor Dave Boliek. “Medical suspensions and license limitations are serious prohibitions that need to be treated as such. To ensure Medicaid patients have safety and trust with their physicians, it’s important that the government promptly addresses the Medicaid provider issues found in our latest report.”
Here are the key findings of the report
The audit found that the division did not identify and remove providers who entered into Non-Practice Agreements with the professional licensing board.
The division declined to evaluate the risk that providers with limitations on their licenses may pose to patients or remove any of the providers from the Medicaid program.
The division failed to verify that the enrolled providers possessed a United States Department of Justice’s Drug Enforcement Administration (DEA) certification.
Finally, the division did not corroborate ownership information of providers during the Medicaid provider enrollment re-verification process.
The Bottom Line: As a result, there was an increased risk that providers whose actions posed a threat to patient safety were enrolled in Medicaid and could receive payments from North Carolina’s Medicaid program.
Some eye-catching examples of abuse quoted directly from the report:
Provider A: Treated 21 Medicaid patients and received $1,311 in payments despite being under a Non-Practice Agreement for practicing medicine while abusing alcohol.
Provider B: Treated 14 Medicaid patients and received $5,415 in payments despite being under a Non-Practice Agreement for inappropriately prescribing controlled substances and medications to friends and romantic partners.
Provider C: Billed Medicaid for services provided to 78 Medicaid patients, including 21 female patients, despite a license limitation restricting the physician from treating female patients.
Provider D: Remained active in the Medicaid program despite having their Moderate Sedation permit suspended for administering general anesthesia without a permit.
Provider E: Remained active in the Medicaid program despite having a license limitation prohibiting the physician from prescribing controlled medications following a DEA raid.
Key recommendations from the auditors:
The agency should remove all providers who have their licenses suspended, terminated, or entered into Non-Practice Agreements. Additionally, the Division should enact policy and procedures to identify and remove providers who cannot practice or perform any act that requires a license.
Division management should remove all providers from the Medicaid program whose limitations on their professional license pose a safety risk to patients.
The Division should enact policies that verify that all providers possess the DEA certification, given the potential risk posed to Medicaid patients from providers prescribing controlled substances without the required DEA certification.
The Division should verify the accuracy of all providers’ ownership information so that background checks can be performed, identify ineligible providers, and remove them from the system.
