NC needs to reduce costly Medicaid billing errors

The state Department of Health and Human Services last year processed 127 million claims for payment through the federal/state health care plan for the poor and disabled, and the claims were for a staggering $11 billion. A state audit concluded that about $835 million was improperly paid to providers. That may be a small fraction of the total, but it’s still too much. (The federal government pays two-thirds of the money, the state the rest.)

The 13 percent error rate, while disputed by DHHS, is lower than the previous year’s 24 percent. That’s still not bragging rights territory, particularly when Gov. Pat McCrory’s new administration was going to make DHHS more efficient.

Some errors had to do with paperwork, some with payments to providers who weren’t eligible to receive them and some of the sample of errors didn’t show a Medicaid rate cut that was retroactive. The audit looked at a sample of 396 payments to get its findings, and that’s of course a fraction of all the payments. The department says better procedures are in place.

The Medicaid program has had problems with information technology, and former DHHS Secretary Aldona Wos hired a number of outside consultants with fat contracts in various roles. She caused some turmoil with her management style within a department that performs important services for people who need the state’s help. Whether the department is doing better overall under Secretary Rick Brajer, who came to the job after a career mostly in private industry, remains to be determined.

This story was originally published April 5, 2016 at 7:12 PM with the headline "NC needs to reduce costly Medicaid billing errors."