SECRETARY SANGVAI, ATTORNEY GENERAL JACKSON UPDATE LEGISLATURE ON MEDICAID FRAUD PREVENTION AND PROSECUTION

The following information was released by the North Carolina Department of Health and Human Services (DHHS):

NC Health and Human Services Secretary Dev Sangvai and NC Attorney General Jeff Jackson will appear in front of the NC General Assembly House Select Committee on Oversight and Reform this morning. The Committee has invited them to share and respond to questions about NC Medicaid's work to identify and address fraud, waste, and abuse.Please see Secretary Sangvai and Attorney General Jackson's prepared remarks at these links.

NC Medicaid is a fiscally responsible program built with bi-partisan support that provides health coverage to more than 3 million North Carolinians. This is about 1 in 4 residents including children, pregnant women, seniors, people with disabilities, and working families. NC Medicaid also supports rural hospitals, nursing homes and essential care services.

"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," said NC Health and Human Services Secretary Dev Sangvai. "We take our responsibility to prevent, detect and address fraud, waste and abuse seriously, and are grateful for the strong partnership with many state and local agencies in maintaining robust oversight and accountability across the program."

"There is no acceptable level of Medicaid provider fraud," said North Carolina Attorney General Jeff Jackson. "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."

NCDHHS and NCDOJ, in partnership with other state and local agencies, remain firmly committed to safeguarding the integrity of NC Medicaid. The department has built a strong, multi-layered system designed to prevent, detect and address fraud, waste and abuse. These efforts protect taxpayer dollars while ensuring that Medicaid beneficiaries receive appropriate, high-quality care.

North Carolina's eligibility and detection systems continue to demonstrate exceptional performance. With an error rate of just 0.46%, the state maintains one of the lowest eligibility error rates in the nation. The scale of program oversight reflects both the size of NC Medicaid and the strength of its integrity infrastructure. In 2025, 3.1 million North Carolinians were enrolled in Medicaid, and 158 credible allegations of member fraud were reported and investigated. Among 114,454 enrolled providers, 228 credible allegations of provider fraud were identified and pursued. 98% of NC Medicaid funding goes directly toward medical costs.

Rising health care costs are a big issue across the country due to health care inflation, increasing pharmacy spending, high-cost medication and the introduction of new cell and gene therapies. To manage this, NC Medicaid is taking a proactive approach to invest in better health outcomes for North Carolinians that will drive down program costs. Examples include strengthening managed care accountability, managing pharmacy costs, driving operational efficiencies and investing in long-term sustainability. NCDHHS shares the Committee's commitment to accountability and is ready to work together to ensure resources are going toward quality health care for the people who depend on it.

The Attorney General's MID investigates fraud and abuse by health care companies and providers, as well as patient abuse and neglect in facilities that are funded by Medicaid. Medicaid is a joint federal-state program that helps provide medical care for people with limited income. To date, the MID has recovered more than $1.2 billion in restitution and penalties for North Carolina.