Audit: DHHS allowed unlicensed providers to remain in Medicaid program

RALEIGH, N.C. — Dozens of health care providers whose licenses were revoked, suspended or had limits placed on them were allowed to continue treating Medicaid patients – and bill the state for the services – because of lax oversight, according to a scathing audit released Thursday.

Investigators with the State Auditor's Office found that 18 of the 26 providers whose licenses were terminated or suspended in 2019 weren't removed from the Medicaid program, including two who were disciplined for sexual misconduct and one who had been convicted of health care fraud. Fourteen of those 18 were removed only after auditors questioned state Division of Health Benefits officials about them, including a physician assistant who treated more than 550 patients after his license had been suspended for "allegations regarding inappropriate exams of female patients."

Another 36 providers who had limits placed on their licenses by various state boards also were allowed to continue serving Medicaid patients, including a physician who reused syringes on multiple patients, two others who weren't supposed to treat female patients and an oral surgeon who lost his dental license after the death of a patient but still had a medical license.

Auditors determined that Division of Health Benefits officials didn't check the disciplinary actions taken by various state licensing boards, relying on an electronic system that hadn't worked since it was put in place in 2015. Agency officials also told auditors they didn't have the authority to remove providers from the Medicaid system simply because of limits placed on their licenses, but federal Medicaid regulations state that each state must confirm "there are no current limitations on the provider's license."

Read more: https://www.wral.com/audit-dhhs-allowed-unlicensed-providers-to-remain-in-medicaid-program/19533852/