(The Center Square) – A North Carolina legislator and physician on Thursday issued a scathing critique of the state’s Medicaid program, citing spiraling costs, enrollment and administrative costs and “stagnant” fraud investigations.
Instead of heavily relying on data to detect fraud, North Carolina is still using tips from “whistleblowers,” Rep. Grant Campbell, R-Cabarrus, said during a meeting of the Select Committee on Oversight and Reform in the House of Representatives.
“We must ask, ‘How many millions are being lost to waste, fraud of abuse before a single case is opened?’” Campbell said.
He cited autism therapy as one area that needs closer scrutiny.
“Applied behavioral analysis therapy is essential for children with autism,” the legislator said. “But a sharp rise in new autism diagnoses led this body to raise reimbursement rates 15%. That combination has driven provider claims up astronomically and drawn private equity firms into the market. Worried parents and free-flowing money create opportunity for bad actors.”
First-term Republican state Auditor Davel Boliek recently hired a new staff member to lead a team focusing on Medicaid fraud. His office singled out autism therapy as one of the areas that will be investigated.
Since 2019, Medicaid enrollment in North Carolina has increased from 1.9 million to 2.9 million, which is more than the entire population growth of the state in that period, Campbell said. It was aided by expansion on Dec. 1, 2023.
“This is the highest percent increase of any state in the nation,” the legislator said. “During this period, several other states enacted Medicaid expansion and every state experienced COVID. Yet we outpaced them all.”
The cost of the North Carolina program has increased to $36 billion annually, with the federal government paying about $30 billion and the state $6 billion.
“That is taxpayer money and it requires commitment to vigilant oversight,” said Campbell.
First-term Democratic Attorney General Jeff Jackson defended the state’s Medicaid fraud investigation efforts, both criminally and in civil courts.
Under federal law, states can only prosecute or sue Medicaid providers, not recipients, Jackson said.
North Carolina’s Medicaid Investigations Division is “punching way above its weight” compared to other states, the attorney general said.
“We are nationally regarded as one of the finest and most effective Medicaid fraud investigation divisions in the country,” Jackson said. “We are fourth in the nation for how much we recover per federal dollar of funding.”
