NC's Four Medicaid MCOs Launch Joint Fraud Task Force

North Carolina's four Medicaid managed care organizations, AmeriHealth Caritas, Healthy Blue, UnitedHealthcare and Carolina Complete Health, formed a joint task force in August through the North Carolina Association of Health Plans to combat fraud, waste and abuse. The task force unites each plan's special investigative units and government relations staff so investigators can share billing data and coordinate on providers that contract across multiple MCOs. The effort emerged from a meeting with State Auditor Dave Boliek amid heightened federal and state scrutiny of Medicaid spending, including recent fraud cases involving a substance abuse treatment center and a nursing home. Organizers say applied behavioral analysis therapy billing is a top area of concern given rapidly rising spending.

Managed Care · Behavioral Health · Finance