Audit: NC could be overpaying in health claims

RALEIGH, NC (AP) -- A new audit says North Carolina's state health plan for workers could be overpaying millions of dollars a year because of shoddy tracking of medical claims.

State Auditor Beth Wood's office released an audit Tuesday estimating that the North Carolina State Health Plan for Teachers and State Employees may have overpaid more than $48 million between the 2008 and 2010 fiscal years.

The audit says the state plan doesn't follow up on potential overpayments identified by outside companies hired as auditors. The report also says officials don't provide adequate oversight on those outside companies.

The state plan ensures about 662,000 teachers, state employees, retirees and other groups. In the last fiscal year, it paid out roughly $2.4 billion in claims.

(Copyright 2011 by The Associated Press. All Rights Reserved.)

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Because truth be told it could be either. Im fighting BCBSNC for stupid reasons because they swear up and down that my back injury doesnt require fusion surgery despite 3 MDs saying otherwise and guess what so far they are getting away with it. I have to really laugh when articles like these come up. Just means somebodys pissed off they arent getting a bonus and the "overpayments" are in fact legit medical expenses that some paperpusher forgot to deny deny deny like they so love to do for legitimate medical expenses. Im disgusted by BCBSNC and quite frankly think they are corrupt to the Nth degree. All I can say is becareful what you wish for for "reform" because next thing you know they'll decide your medical procedure isnt "medically necessary" either. In the end BCBSNC doesnt care about anybody but their bottom line and if somebodys complaining about overpayments going out its obviously somebody griping about their year end bonus instead of it truly being legit about concerns of money. Its the cold hard truth if you dont believe it ASK the NC Dept of Insurance cause they'll tell ya the hard truth about the down and dirty games insurance companies will play until you get the DOI on your side (they helped me as much as they could but then turned out my policy was 'federally' regulated which is a nice way of saying Im screwed!!! The only way I can beat them if I lose my final appeal is ot file a federal ERISA lawsuit against BCBSNC which means hell will likely freeze over before I ever get my back surgery they'll probably hope Ill die before they lose the case and lawyers hate these cases because unless I can prove Bad faith the money isnt much.

Read some related articles in the Winston Salem papers about an employee of Baptist Hospital informed his superiors about overcharging and was fired. How's that for gratitude. The State Health Plan needs MAJOR overhauls to remain solvent in the coming years.
Time to call Janet Cowell in Raleigh and tell her to get this fixed or the budget will be really in trouble in 2 years.

The public sector needs to pay what the private sector does for insurance and for there retirement.Just look at the latest cencus
on how households are doing and all the homes underwater.State,county,city taxes and fees are out of control,along with property insurance and taxes.Where are the people with common sense when it comes to government.They say people want a handout it is the government wanting there hand in the taxpayers pocket in every way