PER-2024-4445

The audit found that the Department of Health and Human Services, Division of Health Benefits (Division) did not fully implement recommendations made in OSA’s February 2021 Medicaid Provider Enrollment performance audit report. Specifically, the Division did not:

• Identify and remove providers that entered into Non-Practice Agreements with professional licensing boards.
• Evaluate the risk providers with limitations on their licenses may pose to patients nor remove any of the providers from the Medicaid program.
• Verify that enrolled providers possessed a United States Department of Justice’s Drug Enforcement Administration (DEA) certification.
• Corroborate ownership information of providers during the Medicaid provider enrollment re-verification process.

As a result, there was an increased risk that providers whose actions posed a threat to patient safety were enrolled in Medicaid and could receive payments from North Carolina’s Medicaid program.

Details about each item are provided in the Findings and Recommendations section of the report. The Division did not agree with all the findings in the report. As a result, the report includes a State Auditor’s Response to ensure readers have complete and accurate information and are not misled.