North Carolina AP audit identifies $48 million in health insurance overpayments

The results of an accounts payable audit recently released by the state of North Carolina identified numerous instances of insurance plan overpayments and duplicate payments for state workers and teachers over the past three years, according to the News & Observer.

"What may be an overpayment could have a number of reasons," said Lew Borman, spokesman for Blue Cross Blue Shield. "It could be a provider or patient issue, or it could be our issue as well."

The AP audit found that excess fees were disbursed improperly in a number of ways. These included payments to those ineligible for coverage, fulfilment of claims for inappropriate or unnecessary services, and benefit payments that should have been covered or partially covered by Medicare or a similar policy.

Lacey Barnes, interim executive administrator of the State Health Plan, noted that the $48 million in overpayments comprised approximately 1 percent of the $5.3 billion in claims paid over the time period covered by the audit.

"Another way to look at it is we were 99 percent accurate over these years," she said, as quoted by the news source.

Conducting recovery audits can help organizations recoup overpayments and mitigate losses caused by both fraudulent and unintentional billing errors.  

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