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DHHS Inks Medicaid Anti-fraud Deal with SAS

For release: Immediate    Dec. 21, 2010
Contact: Brad Deen, 919-733-9190

RALEIGH — In its ongoing efforts to reduce Medicaid fraud and waste, the Department of Health and Human Services has reached an agreement with SAS that could reap tens of millions of dollars in taxpayer savings.

Gov. Bev Perdue announced the agreement today at SAS campus in Cary, where the homegrown software leader announced the creation of 100 jobs in its new state and local government Analytics Lab.

“This program will help us make sure that Medicaid benefits go to the people who are supposed to get them and help us uncover fraud,” Gov. Perdue said. “These efforts are part of my core priority of setting government straight, making it work more efficiently for the people of North Carolina.”

The agreement, finalized Monday, calls for DHHS to license SAS Fraud Framework for Government software for one year at $2 million, with options for up to two additional years for about $300,000 in license fees annually. The software will analyze N.C. Medicaid recipient data for indications of fraud and abuse.

The SAS program is estimated to save at least $25 million, as that’s the amount of suspicious claims that were identified during two joint DHHS-SAS exercises last year that looked at only a few Medicaid claims groups: durable medical equipment, dental, prescription drugs, community support and personal care services.

In the past year, DHHS has made significant strides in upgrading technology with an emphasis on closing the gaps where Medicaid fraud and waste can occur. The replacement of Medicaid’s computer system, which incorporates high-tech analytic software to detect suspicious activities by Medicaid recipients and providers, is anticipated to go online Oct. 1, 2012. DHHS has made short-term arrangements with SAS, to sift recipient data, and with IBM, to comb through provider claims.

Approximately 1.5 million low-income or disabled North Carolinians currently receive health care coverage through N.C. Medicaid, which has a budget of more than $12.7 billion for the current fiscal year.