by Angela Guess
The North Carolina Department of Health and Human Services reports that IBM software “designed to root out potentially fraudulent Medicaid claims has uncovered 206 outpatient behavioral health providers across the state with unusual Medicaid billing worth up to $191 million. North Carolina is the first state in the nation to track possible fraud in this way. Around 100 of those providers are in the greater Triangle region and more than 40 in the Charlotte region. The Wilmington area had 17 and Greenville and surrounding counties had 24. A complete regional list is below.”
The article notes, “Providers intent on defrauding Medicaid have been good at evading detection – until Governor Perdue directed DHHS to contract with IBM for a sophisticated data analysis software program. The program can detect billing behaviors that suggest fraudulent behavior, and also shows relationships among providers that could point to other providers that may be abusing the Medicaid program. North Carolina is the first state to use the IBM software to track down Medicaid fraud.”
