Amid growing concerns about Medicaid fraud, North Carolina legislators are urging a more robust investigative approach to safeguard the program’s integrity. During an extensive state House committee session, Attorney General Jeff Jackson and Health and Human Services Secretary Dev Sangvai faced critical inquiries regarding the extent of fraudulent activities within the state’s Medicaid system.
Rep. Grant Campbell, R-Cabarrus, highlighted instances of dubious billing practices by Medicaid providers, citing examples such as a business ostensibly operating from a deserted storefront and others with unusually high travel and cash expenditure reports.
“Rooting out waste, fraud and abuse isn’t just a fiscal issue, it is a moral one,” Campbell emphasized. “Every dollar misused is a dollar not spent on a child with autism, a senior needing care or a patient waiting for treatment. … We keep talking about how we have no money to look into this, and we had two staffers with Google and an Excel sheet in less than two hours came up with these figures, these filings and these locations.”
While Sangvai was unfamiliar with the specific providers cited by Campbell, Jackson suggested that these cases might not meet the threshold for criminal prosecution. “I think you just made an excellent case for why we should double down on data mining, because while all of that was compelling, none of it survives a grand jury,” Jackson noted. “None of it is sufficient.”
Jackson proposed the legislature allocate funds for a data mining specialist, advocating the use of AI tools to enhance fraud detection. “I’m asking you for one position because I’m very confident that with that position, I can come back to you in a year and show you a solid return on investment,” Jackson stated. “I want to get more aggressive in going after Medicaid provider fraud. This is the most cost-effective way.”
Rep. Tim Reeder, R-Pitt, pointed out that the hearing was spurred by significant Medicaid fraud incidents in states like Minnesota and California. “We’ve seen what’s happened in other states, Minnesota and California, where there’s been tremendous fraud with millions and billions of dollars,” Reeder said, seeking assurances that North Carolina would avoid similar pitfalls.
However, House Democratic Leader Robert Reives highlighted previous legislative decisions to cut the attorney general’s office staffing. “I would advocate that if we’re serious about this, that we provide resources, because to this day, we have not been able to legislate more hours in a day,” Reives argued. “And if you don’t have enough staff, and you don’t have enough resources, and you don’t have enough systems and software and upgrades, then you’re behind folks who may defraud the system.”
Beyond fraud, the Medicaid program faces financial challenges. Sangvai alerted lawmakers that without a $319 million allocation soon, the program could deplete its funds by May.
