Medicaid claims system had more than 3,200 defects

by Lynn Bonner, Charlotte Observer, December 10, 2013.

The state audit released Monday put a number to all the problems with a new Medicaid claims system that has frustrated hospitals, doctors and other health care providers for months.

NC Tracks has had more than 3,200 defects since the state started using it July 1, according to the report, and more than 600 had not been fixed by Nov. 5.

“Critical” problems have declined, but the number of new “high” and “medium” defects reported each month remained relatively consistent. Defects rated “high” accounted for 74 percent of unfixed problems. The audit period ran from July 1 to Nov. 6.

The state Department of Health and Human Services said Monday that 81 percent of the defects have been addressed, and those that are left don’t affect the majority of providers.

In addition to counting the defects, the audit says that:

• 12 out of 14 changes required by the legislature or federal government were not in place by target dates.

• A former DHHS employee who was the NC Tracks senior program manager now works for the vendor, Computer Sciences Corp., as the NC Tracks executive account director. DHHS approved the arrangement in August. The audit said the “revolving door” creates a perception of conflict of interest.

• DHHS didn’t have a master plan for tracking problems and making corrections. In its response, DHHS said it was putting all that together, and it will be ready by Jan. 1.

Health care providers have inundated legislators with horror stories about problems they’ve had getting paid for treating Medicaid patients. In public meetings over the past two months, legislators have questioned DHHS officials and a representative from Computer Sciences Corp., the company hired for $484 million to build and run the claims system until 2020. A legislative committee is set to talk about the system again Tuesday.

The N.C. Medical Society, the trade group for doctors, said the audit confirmed its worst fears, and definitive action is needed for fixes.

“This flawed system has been hurting patients and hurting doctors throughout the state since it went live on July 1,” the group’s CEO, Bob Seligson, said in a statement. “We heard about the problems from our members then, and we continue to hear about them to this day.”

The report from state Auditor Beth Wood offers a comprehensive look at NC Tracks from an office not involved in running it.

Medicaid is the government health insurance for poor children and parents, and the elderly and the disabled. The state sent emergency payments to some providers that have had problems getting their money through NC Tracks. The software problems put a hitch in treatment for some people. A medical office manager told legislators last week that hundreds of children went without the glasses they needed to start the school year because of problems processing the proper forms.

In its response to the audit, DHHS said that NC Tracks had fewer defects than the industry average for a software system of its complexity.

As he has since NC Tracks first got rolling, Joe Cooper, the computer systems chief at DHHS, said providers are getting paid.

“NC Tracks has processed 81 million claims and paid almost $4.5 billion to North Carolina healthcare providers, but it is clear that there is still work to do,” he said in a statement that laid out the department’s position that most defects have been corrected.

“Our primary focus continues to be to make system improvements and to ensure that every provider is paid for the work they do,” Cooper’s statement continued. “But if even one provider is impacted negatively, that’s one too many.”