Under the Dome: The providers who shouldn’t have been providing

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Lucille Sherman
·3 min read
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Happy Friday. Today, we’re revisiting some less-new (but still important) news.

You might have seen a handful of stories my colleagues Will Doran and Dan Kane wrote about a report State Auditor Beth Wood released in February.

Here’s what it found:

  • 18 medical providers with suspended or terminated licenses were still receiving Medicaid payments from North Carolina’s Department of Health and Human Services, even though they weren’t supposed to be practicing.

  • After they were disciplined, those providers continued to see some 2,400 patients and received $1.64 million.

  • Some of those providers had been disciplined for substance abuse, sexual misconduct, or even health care fraud, but continued to be eligible to see patients and receive payments.

Seven years earlier, Wood found many of the same problems within the state’s Medicaid system. An audit in 2014 revealed that DHHS didn’t provide much justification for allowing some health care providers to continue seeing Medicaid patients. So in 2019, Wood’s office checked back in to see if the system had weeded out bad actors. That wasn’t the case.

How did this happen? A state employee wasn’t checking. After the 2014 audit, the state set up a system meant to notify the department each time a provider was terminated or suspended. No notifications ever arrived, and the employee assumed no providers had been disciplined, the audit said.

Here’s why it matters: Some of the state’s most vulnerable continued to be cared for by providers who were not qualified to practice. And Wood’s office only investigated a small sample of providers. Wood’s might find more problems if auditors investigated a larger sample.

Listen to our latest podcast for more insight and analysis on the audit. Subscribe wherever you get your podcasts. (Pandora, Spotify, Apple Podcasts, Stitcher, iHeartRadio, Amazon Music, Megaphone.)

2022 CANDIDATE WATCH

  • Lara Trump said she is “absolutely” considering a U.S. Senate run, The Hill reported. So... we still don’t know for sure if she’ll throw her name in the hat.

WHAT WE’RE READING

MORE BIG STORIES FROM THE TEAM

Thanks for reading.

— Lucille Sherman, state government reporter for The News & Observer. Email me at lsherman@newsobserver.com.

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