North Carolina lawmakers press state officials over Medicaid shortfall and fraud concerns

RALEIGH, N.C. (WTVD) -- North Carolina lawmakers pressed state officials Thursday during a high-stakes hearing on Jones Street over an ongoing Medicaid shortfall and allegations of fraud.

Attorney General Jeff Jackson and North Carolina Department of Health and Human Services Secretary Dev Sangvai were questioned about possible fraud and the process for investigating fraud, as lawmakers remain at an impasse over the funding in the absence of a new state budget.

State health officials said they need an additional $319 million for this year's Medicaid rebase, which they say is necessary to keep pace with rising costs and enrollment. Governor Josh Stein has also called on lawmakers to pass additional funding for Medicaid.

But some lawmakers argue the numbers presented by the administration do not add up. During the hearing, legislators noted that North Carolina ranks near the top nationally in recent Medicaid enrollments but near the bottom in fraud investigations and the amount of money recovered.

"We must ask how many millions are being lost to waste, fraud or abuse before a single case is opened? How many investigations result in convictions, settlements or recoveries? And how long does it take to intervene once red flags appear?" said committee chair Grant Campbell.

Jackson defended the state's efforts, saying, "There is no question that North Carolina is punching way above its weight. We are nationally regarded as one of the finest and most effective Medicaid fraud investigation divisions in the country."

Lawmakers also argued that more should be done to investigate potential fraud and establish a clearer connection between those cases and criminal action.

Jackson said he remains confident in the process and noted that federal law prohibits his office from pursuing individual beneficiaries, focusing instead on Medicaid providers because the program is largely federally funded.

"Proving fraud civilly is easy from an evidentiary standpoint, compared to proving fraud criminally," Jackson said. "We take our cases criminally every time the evidence supports it. But there are some cases where the evidence just doesn't support it, because to take it criminal, you have to prove intent."

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