North Carolina Addresses Medicaid Fraud

This is an editorial from the Wilmington Star:

Article published Jul 28, 2005
The right ways to cut costs

North Carolina is choosing the smart and humane way to confront unsustainable increases in the cost of medical care for the poor: Don’t kick thousands of people out of the program; catch medical outfits that defraud it.

Gov. Mike Easley’s administration and Attorney General Roy Cooper had already started cracking down on suspicious claims filed by doctors and medical companies.

The Medicaid office hired more than a dozen investigators. Prosecutions rose sharply, along with repayment to the state for unjustified bills. Last year, the state collected $26.1 million – almost six times as much as in 2000.

Now the new head of the Medicaid office promises an even more energetic pursuit of criminal chiseling. Among other things, he says he’ll adopt some of the techniques that private insurance companies use to sniff out fraud.

Good. The rising cost of Medicaid – now about 12 percent a year – is cutting deeply into the budgets of the state and its counties.

Yet the needs of Medicaid recipients, including children, the disabled and nursing-home patients, are real. Cutting 65,000 of them out of the program should be unthinkable.

The state Senate thought it anyway. House negotiators, to their credit, refused to be accomplices to such cruelty.
This is a national crisis that demands a national solution. But until the White House and Congress start confronting real problems instead of playing political games, the states will have to cope.

North Carolina is trying to do it right. How much longer it can do it right is the question.