ND Only State Without Medicaid Fraud Control Unit

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When it comes to government programs, one of the biggest criticisms is the possibility for fraud and abuse.

North Dakota is a leader in many areas, but stands out in a seemingly peculiar way when it comes to Medicaid.

Every state in the country has a Medicaid Fraud Control Unit, that is every state except for North Dakota.

This is despite the fact that the Office of the State Auditor testifying to the Legislative Audit and Fiscal Review Committee that the condition is ripe for fraud and abuse.

"Back when we did the original audit, there really was no action taken in relation to those indications, or very limited actions taken. Part of the reason was a resource issue," says Jason Wahl, state performance audit manager.

"I support establishing a fraud and abuse unit, let me make that clear, but part of the issues have been wrapped around the fact we have had an antiquated system for doing this, requiring tremendous amounts of staff time and the potential for error," said Sen. Judy Lee, R-West Fargo.

The state was granted a waiver in 1994 to operate without a fraud unit because back then it would have cost more to run than it would have recovered. Now, with digitalization projects like the Medicaid Management Information System, which launches here later this year, it should be easier to recognize bad claims.

"That's one of the purposes behind it is to have more accurate payments, more timely payments, providers to be able to send things in an electronic format and attach documentation to those, so it reduces some of the manual processes," says Maggie Anderson, Department of Health Services executive director.

The Department of Health Services testified that a bill was introduced to fund a task force this session, but the language was changed to study the issue instead. That study was not chosen by legislative management, so the issue has essentially been tabled.

The State Auditor's Office also held Dickinson State's feet to the fire during Thursday's meeting. The auditor called out the college for charging remote education students fees for on-campus amenities, including those attending at BSC. The university responded by saying it was following board policy and that it was difficult to determine who qualifies as a true remote student.