N.C. and IBM team up to ferret out Medicaid fraud

Perdue puts patients and providers on alert, predicts huge savings

staff writerMarch 25, 2010 

— Gov. Bev Perdue announced an effort Wednesday to track down Medicaid fraud by creating a partnership with IBM to discover abuses by patients and their health care providers.

IBM will use its software to comb through the records of 60,000 health care providers and 2 million North Carolinians who are insured through the federal program for the poor and disabled.

"It is pretty evident to us that we have to do more to root out the waste and crack down on the people that we know are out there who are abusing the system," Perdue said at a news conference at Rex Healthcare, where she stood in front of cardiac catheterization monitors.

The governor said the project with IBM would be combined with other efforts, including a new state legislative proposal to toughen laws against kickbacks to health care providers, a publicity campaign to get people to report fraud and efforts to secure money to hire more anti-fraud investigators.

Perdue said that Medicaid was a valuable program but that in these difficult financial times, it was even more important that taxpayers were not being ripped off.

The partnership with IBM, which is being tested, will be fully implemented by this summer.

Lanier M. Cansler, the secretary of health and human services, said IBM agreed to undertake the analysis of the Medicaid records in return for getting 10 percent of all the fraud money recovered. IBM has successfully run a similar Medicaid fraud analysis for the New York Association of Counties.

The proposal originally was made by the N.C. Budget and Reform and Accountability Commission, which Perdue appointed to make recommendations about how to trim and make state government more efficient.

Perdue said IBM had already examined 2007 Medicaid records in North Carolina while testing its programs and came up with numerous examples of questionable activity that have interested investigators.

In one instance, a provider billed Medicaid for 800 days of work in one year. In another, a provider of prosthetic limbs billed for 45,000 "miscellaneous limbs" rather than specifying arms or legs as required by law, the governor said. This provider had one of the highest per patient Medicaid claims in the state, she said.

"I think we are going to save tens of millions of dollars," Perdue said.

rob.christensen@newsobserver.com or 919-829-4532

News & Observer is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service