Office of Inspector General's Partnership Plan - Review of the North Carolina Division of Medical Assistance's Reimbursement for Clinical Laboratory Services Under the Medicaid Program

EXECUTIVE SUMMARY:

This audit was a joint effort by the Office of Inspector General and the North Carolina Office of the State Auditor. The audit disclosed that the State agency does not have adequate edits in place to prevent the payment of unbundled or duplicated claims for certain laboratory services. A statistical sample of 300 claims showed that 297 claims were not paid correctly. We estimate that the State agency overpaid providers $1,282,509 (Federal share) for certain laboratory tests for calendar years 1993 and 1994. In addition to financial adjustments, we recommended that the State agency install edits to detect and prevent payments for unbundled services and billings which contain duplicate tests. State agency officials generally concurred with our recommendations.