State lawmakers are calling for stronger efforts to investigate fraud and abuse in North Carolina’s Medicaid system. A state House committee held a nearly three-hour hearing Thursday on the topic, questioning Attorney General Jeff Jackson and Health and Human Services Secretary Dev Sangvai.
Rep. Grant Campbell, R-Cabarrus, says his staff found several examples of suspicious billing from Medicaid providers. One appeared to be headquartered in an abandoned storefront, and another reported high travel expenses and cash withdrawals.
“Rooting out waste, fraud and abuse isn’t just a fiscal issue, it is a moral one,” Campbell said. “Every dollar misused is a dollar not spent on a child with autism, a senior needing care or a patient waiting for treatment. … We keep talking about how we have no money to look into this, and we had two staffers with Google and an Excel sheet in less than two…
This category refers to crimes committed by employees or insiders against their own organizations. It is often the most damaging because the perpetrator has authorized access to systems.
- Asset Misappropriation: The most common form, involving the theft of company resources. This ranges from simple “skimming” (taking cash before it’s recorded) to complex schemes involving the theft of inventory or intellectual property.
- Payroll Fraud: Employees may create “ghost employees” on the system, falsify their own timesheets to claim unworked overtime, or divert salary payments to their own accounts.
- Financial Statement Fraud: Management deliberately misrepresents the company’s financial health by inflating revenue or hiding liabilities to attract investors or meet performance bonuses.