NC Leaders Address Medicaid Fraud, Waste, and Abuse at Oversight Hearing

In a critical meeting today, North Carolina’s top officials will address the state’s ongoing efforts to combat Medicaid fraud, waste, and abuse. NC Health and Human Services Secretary Dev Sangvai and Attorney General Jeff Jackson will present their strategies and respond to inquiries from the NC General Assembly House Select Committee on Oversight and Reform. For more details, access their prepared remarks here and here.

NC Medicaid plays a pivotal role in providing health coverage to over 3 million residents, or nearly one in four North Carolinians. This group includes children, pregnant women, seniors, people with disabilities, and working families, demonstrating the program’s widespread impact. Additionally, NC Medicaid supports vital rural hospitals, nursing homes, and essential care services throughout the state.

Dev Sangvai highlighted the program’s commitment to integrity, stating, “Protecting the integrity of NC Medicaid is essential to both safeguarding taxpayer dollars and protecting the life-saving care millions of people depend on in North Carolina.” He emphasized the importance of a robust collaborative effort with state and local agencies to maintain oversight and accountability.

Attorney General Jeff Jackson further emphasized the zero-tolerance policy towards Medicaid provider fraud, remarking, “There is no acceptable level of Medicaid provider fraud. My Medicaid Investigations Division is a national leader in finding and rooting out fraud by health care providers, and we’re going to keep at this work to protect North Carolina’s health care tax dollars.”

The NC Department of Health and Human Services (NCDHHS) and the North Carolina Department of Justice (NCDOJ) have established a multi-layered system to tackle fraud, waste, and abuse. With a remarkably low eligibility error rate of 0.46%, North Carolina stands out nationally for its effective oversight of Medicaid. In 2025, the program saw 158 credible allegations of member fraud and 228 credible allegations of provider fraud among over 114,000 providers.

In response to rising healthcare costs driven by health care inflation and new therapies, NC Medicaid is proactively investing in better health outcomes to reduce costs. This includes initiatives to strengthen managed care accountability, manage pharmacy expenses, and improve operational efficiencies.

The Medicaid Investigations Division (MID) plays a crucial role, targeting fraud and abuse by healthcare providers and ensuring patient protection in Medicaid-funded facilities. With over $1.2 billion recovered in restitution and penalties, the MID is a formidable force in safeguarding state resources.

Funding for MID is jointly sourced, with 75% provided by the U.S. Department of Health and Human Services, amounting to $8,561,152 for Federal fiscal year 2026, and the remaining 25% funded by North Carolina. To report Medicaid fraud, individuals can contact the North Carolina Medicaid Investigations Division at 919-881-2320 or utilize the Tip-Line at 877-362-8471 or 919-527-7749. An Online Confidential Complaint Form is also available.