Auditor’s Report Reveals Improper Medicaid Payments to Providers With Revoked Licenses, Some for Sexual Misconduct with Patients

Scathing report shows ineffective Medicaid management, oversight

Sen. Krawiec: “Medicaid is not the golden program some partisans make it out to be”

Raleigh, N.C. — State Auditor Beth Wood, a Democrat, today released a scathing audit of North Carolina’s Medicaid program.

The audit reviewed a small sample of the state’s 90,000 health providers who receive Medicaid payments for services to Medicaid enrollees.

It found that the N.C. Department of Health and Human Services (DHHS), which runs and oversees the state’s Medicaid program, “did not identify and remove enrolled providers from the Medicaid program who had their professional license suspended or terminated,” and “allowed all providers who had professional license limitations to remain enrolled in the Medicaid program.”

The audit provided examples of providers whom DHHS allowed to remain in the Medicaid program and receive Medicaid payments, potentially endangering patients:

• “A physician assistant treated 564 beneficiaries from April 26, 2018, the date of suspension, through June 30, 2020. The provider’s license was suspended for allegations regarding inappropriate exams of female patients, not complying with a chaperone requirement, and watching pornography while on duty in an emergency department.”
• “A physician treated 1,775 beneficiaries from January 31, 2018, the date of suspension, through June 30, 2020. The provider’s license was suspended for ‘access[ing] medical records of at least one patient and read[ing] an electro-cardiogram’ while under the influence of alcohol.”

Sen. Joyce Krawiec, who co-chairs the Senate Health Care Committee, said, “Medicaid is a very large government-run program and it’s not realistic to expect there to never be problems. But the oversight failures identified by the auditor seem so basic and so problematic that it raises serious questions about DHHS’s ability to administer the program. Worse, the very people responsible for these failures advocate for adding 500,000 people to its rolls.”