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Almost Three Dozen Medicaid Cases Referred to Law Enforcement

DHHS wrapping up investigations of nearly half of cases identified by IBM

North Carolina Department of Health and Human Services
News Release - July 25, 2012
Contact: Chrissy Pearson , DHHS Public Affairs, 919-855-4835

Raleigh — North Carolina Department of Health and Human Services Secretary Al Delia today announced the latest results of investigations into questionable billing practices by Medicaid outpatient behavioral health providers identified using IBM data analytics software.

As of today, 75 cases have been reviewed and 35 cases totaling $21 million were referred to the special Medicaid Investigations Unit of the Attorney General’s office.

Investigators continue to collect information on the other cases and, where possible, to take action to recoup overpayments.

These cases come as a result of a review using IBM data analytics software of Medicaid outpatient behavioral health providers. The program can detect billing behaviors that suggest fraud, and can point to other related providers that may be abusing the Medicaid program. North Carolina is the first state to use the IBM software to track down Medicaid fraud.

Thirteen of the referred providers were in Wake County, four in Durham, three in Robeson and two each in New Hanover and Franklin counties. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland.

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