N.C. Medicaid and DOJ Collaborate to Stop Fraud, Waste and Abuse

Pictured from left: MID Director Charlie Hobgood, OCPI Director John Thompson and DHHS Assistant Secretary for Medicaid Transformation Jay Ludlam.

Jan. 29, 2018 — The N.C. Medicaid Office of Compliance and Program Integrity (OCPI), part of DHHS, and N.C. Department of Justice Medicaid Investigations Division (MID) held a joint training for their teams at the N.C. Museum of History in Raleigh.

OCPI Director John Thompson welcomed the 135 attendees with a summary of the annual training's mission: "We have to ensure Medicaid dollars serve the right people with the right providers for the right services."

The overriding theme was successful collaboration between OCPI, MID and their partners. These partners include subject matter experts, behavioral health managed care organizations (LME/MCOs) and other law enforcement agencies.

Thanks to teamwork between both organizations and their partners, there were 18 criminal convictions and 20 civil settlements in 2017 for Medicaid fraud, waste and abuse, totaling $36.5 million in restitution and penalties.

DHHS Assistant Secretary for Medicaid Transformation Jay Ludlam discussed expected changes due to Medicaid transformation, including engaging with as many as 15 plans, more reliance on data and the need to become more "outcome oriented."

"Close ties with OCPI and MID allow DHHS to locate potential risks during program design and contract development," Ludlam said.

Other presentations explored ways to efficiently use data to recoup funds, lessons from relationships with existing LME/MCOs, and case studies involving dental and durable medical equipment services and supplies.

Karen Mann