A recent performance audit by the North Carolina Office of the State Auditor (OSA) has identified significant patient safety issues within the state's Medicaid program. The audit revealed that the North Carolina Department of Health and Human Services (DHHS) has not resolved issues previously identified in a 2021 audit, leading to Medicaid providers with restricted licenses still treating patients and receiving state funds, according to a recent press release.
Several medical providers were discovered dealing with patients and submitting claims for reimbursement despite having significant restrictions on their licenses; for example, Provider A, who was supposed to refrain from practicing due to alcohol abuse, treated 21 Medicaid patients and received $1,311, while Provider B engaged in inappropriate prescription practices and still managed to treat 14 patients, getting $5,415. Provider C billed for treating 78 patients, including 21 female patients which they were restricted from treating due to a license limitation. Provider D continued in the program even after their permit for Moderate Sedation was suspended for misuse and Provider E was still active despite not being allowed to prescribe controlled medications after a DEA raid.
State Auditor Dave Boliek emphasized the gravity of these oversights, stating, "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," as per the OSA report. He stressed that suspensions and license restrictions are significant and should be taken seriously in order to guarantee Medicaid patients' safety and confidence in their care providers.
The OSA audit included six recommendations for the Department of Health and Human Services (DHHS), one of which advised the immediate removal of any Medicaid providers whose professional license restrictions may pose risks to patient safety. The audit also highlighted a $1.5 billion contract with General Dynamics Information Technology, the company responsible for provider enrollment functions. The OSA recommended that DHHS strengthen oversight of this contract to safeguard state interests and ensure the efficient and effective use of taxpayer funds.
