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Obamacare helping crack down on Medicaid fraud in NC

One little-noticed provision of the federal Affordable Care Act that is now having major effects was the institution of stronger penalties for Medicare and Medicaid fraud along with better anti-fraud enforcement across the health system.  The new health law upped penalties for fraud, especially in losses over $1 million, financed new sophisticated computer systems to track claims to find fraud early, and set up mechanisms to encourage coordination between the Department of Justice and health care agencies.

These behind-the-scenes commonsense changes may not play into all the breathless political posturing around the health care law but these stricter rules are already producing results in NC.  The Charlotte Observer reported that a Charlotte counselor was arrested yesterday and accused of at least $650,000 in fraudulent NC Medicaid claims.   Already in related cases two other women have pled guilty, recieved prison time, and have been ordered to pay over $1.4 million in restitution.

The money we save from combating fraud in our public health programs goes to keeping health care affordable and available for those who really need help.  This is one more reason we need to keep implementing the new health care law on track in NC – it’s working.

3 Comments


  1. Alex

    August 24, 2012 at 4:02 pm

    Nice try Adam, but a recent story on the new sophisticated computer systems with SAS, IBM, etc says there has been little success detecting Medicaid fraud in this state. Most of it goes undetected and amounts to billions of dollars nationwide. In most cases the money is all gone by the time we catch them. If you remember , Obama talked about this four years ago, so why is it even taking this long to start anything.

  2. david esmay

    August 27, 2012 at 8:35 am

    Ask your GOP congressmen, since they have blocked, or tried to block any reforms on any program put forth.

  3. NCProvider

    August 30, 2012 at 8:54 pm

    I don’t think so. Alex is correct and not only is he correct, but Obama’s policies have been a huge burden on honest providers. Thanks to the AHCA provisions mentioned above, the state’s hired guns, Public Consulting Group (PCG) can routinely audit any provider; and, if they find a progress note out of order can demand that the provider pay an astronomical amount of money based on a statistical formula that may or may not be accurate. Not only that, PCG gets a bonus based on how much money that can get a provider to pay back. There are dozens of cases where their findings were challenged and proven inaccurate; and, the amount the provider would have paid was reduced by 50-75%. This is absolute garbage…oh no…it’s actually change you can believe in!

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