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NCTracks developer CSC faces health care fraud lawsuit in NY

Jason DeBruyn of the Triangle Business Journal wrote:

Jason DeBruyn

Computer Sciences Corporation, the company that designed, developed and is operating the Medicaid claims payment system in North Carolina, is facing a health care fraud lawsuit brought by the U.S. attorney’s office in New York.

That lawsuit has no immediate impact in North Carolina, though Computer Sciences Corp. (CSC) built the system in this state – called NCTracks – using 32 percent of the code used in New York City. Initially, CSC had hoped to duplicate as much as 73 percent of the New York City code in North Carolina.
NCTracks has been the target of several attacks from health care providers who say they have not been paid on time. The N.C. Department of Health and Human Services, where NCTracks is housed, faces a lawsuit that could incorporate 70,000 health care providers and end up with damages exceeding $100 million. NCTracks has been the target of at least three searing audits.

The New York lawsuit, brought by Preet Bharara, the U.S. Attorney for the Southern District of New York, alleges billing fraud schemes that used computer programs to automatically alter billing data, including the use of a defaulting program to systematically falsify diagnosis codes submitted to Medicaid.
“As alleged, CSC and the City created computer programs that systematically, and fraudulently, altered billing data in order to get paid by Medicaid as quickly as possible and as much as possible,” Bharara said through a statement. “Billing frauds like those alleged undermine the integrity of public healthcare programs like Medicaid.”

Although this lawsuit makes no mention of activity in North Carolina, Knicole Emanuel, an attorney with Williams Mullen in Raleigh who represents providers in the lawsuit against DHHS, says it “will almost certainly cause the federal government to peer a bit closer at all CSC’s billing software systems in other states (including North Carolina).”

Representatives from DHHS did not immediately comment on the New York lawsuit.

Effects of Sandy Spreads to the South: Delays in Medicaid Crossover Claims

A Medicaid crossover claim is when a Medicare recipient, who is also covered by Medicaid, visits a health care professional, and the provider submits the medical claims to Medicare. After Medicare processes the claims, the claims automatically crossover to Medicaid.  A crossover claim lifts some of the paperwork burden off the Medicare/Medicaid recipient.

Crossover claim files in NC are all sent to the Centers for Medicare and Medicaid Services‘ (CMS) Coordination of Benefits Contractor (COBC), which has a New York data center. The New York data center used by the COBC to produce and transmit crossover claim files experienced flooding due to Hurricane Sandy.  As a result of this flooding and the need for the COBC to switch over to a disaster recovery site, there have been delays in sending out crossover claim files to the NC Division of Medical Assistance (DMA) and its fiscal agent.  CMS is sending regular updates on its recovery process.

While this delay is concerning for our North Carolina Medicare/Medicaid recipients, let’s remember the disaster and devastation that many people in New York are still facing. We can take the delay. But it is nice to know the reason.