Curbing Medicaid and Medicare fraud has been one of the top goals of the federal government, as well as state government across the country. Investigations and prosecution of those suspected of fraudulent billing have been stepped up. Several new computer programs claimed they could identify fraudulent billers and put a stop to their activities before government funds were distributed. In the case of North Carolina, those claims appear to be largely unfounded.
North Carolina was the first state to use software designed by IBM to find possible fraud. It may serve as a test case to see if other states choose to follow suit in pursuing this type of solution to the problem of improper billing of government entitlement services.
Source: Winston-Salem Journal, “Report: Medicaid fraud detection effort falling short,” 27 July 2012