This Wilmington Star News article disusses the state’s ramped up efforts to curb Medicaid fraud in North Carolina. Of course, the state spends millions on trying to track down fraud and abuse of the massive Medicaid system.
But it doesn’t have to be that way. One of the benefits of the Medicaid reforms I discussed in this September article would include exporting the risk of fraudulent claims to the private health insurance providers selected to offer coverage options for Medicaid enrollees, rather than continuing to put taxpayers on the hook.
Whoever are the winners of today’s election in NC will need to confront many issues when they convene next January – and Medicaid reform should be among them.
This won’t fix the problem unless capitation rates for private companies are adjusted so they have an incentive to prevent fraud. Otherwise, it’s just rolled into the rate base.