WRAL Investigates

NC investigating 206 providers for potential Medicaid fraud

Posted May 22, 2012

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— One day after the WRAL Investigates team reported on potential fraud in North Carolina's Medicaid system, the state Department of Health and Human Services announced that it is investigating 206 providers across the state with unusual Medicaid billing.

Most of the potential fraud cases are local, with 103 in the Triangle, 43 in the Charlotte area and 24 in Greenville and surrounding counties, state officials said. Ten of those cases have been turned over the state Attorney General's Office for review.

The WRAL Investigates team reported Monday that 23,000 billing hours were linked to a licensed therapist in Wake County last year, even though there are only 8,760 hours in a year.

Billing records show psychologist Eunice Ngumba-Gatabaki worked, on average, 60 hours per day, which cost the state $1.79 million last year.

"People should be outraged," said Gov. Bev Perdue. "Those are dollars that aren't there to treat older sick people or children."

Gatabaki's daily average increased last June as records show she worked more than 100 hours per day for 17 days. She says "there may have been some bills inadvertently billed under my provider number that may be attributable to other licensed providers."

Through her attorney, Gatabaki admits she signed off on other therapists' work but says Raleigh-based Rehoboth Consulting did the actual billing.

Gatabaki’s name was also linked to more than $676,000 in Medicaid billing through N.C. Behavioral Health and Counseling. She denies any link to the agency.

Medicaid billing records DHHS cracking down on suspected Medicaid fraud

"It's outrageous," said Rep. Nelson Dollar, R-Wake, who chairs the DHHS oversight committee. "It does make you angry ... We need to make sure not one dime of taxpayer money is being wasted."

Last year, North Carolina spent about $10 billion on taxpayer-funded Medicaid claims, covering everything from doctors’ bills to mental health care for low-income residents. With help from IBM, the state has a new tool to crack down on fraudulent claims, which experts say could make up as much as 2 percent or $200 million each year.

The new fraud detection computer program from IBM uses math and statistics to find abnormalities in Medicaid claims. North Carolina is the first and only state in the country using it.

IBM anti-fraud solutions leader Shaun Barry says the tool helps point investigators in the right direction. “It tells them where to look … what rocks to look under, if you will,” he said.

"The department needs to accelerate their efforts," Dollar said. "I think the IBM solution on this needs to start showing some real results."


Read more WRAL Investigates stories or contact the WRAL Investigates team.

68 Comments

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  • muggs May 23, 3:33 p.m.

    The offering of a reward is possible for turning someone in,yes I know that that would be a terrible thing to do,it's much easier to just let it go on and blame who,if you know it for certain why not,knowing and complaining about it is no better than the state employees that let this episode happen.

  • muggs May 23, 2:46 p.m.

    When we have a President and administration that depends on the very people that are the largest recipients of all these benefits and he wants to give amnesty to many more what chance does the middle class and lower working middle class have,with Pew and the NAACP having such an impact on our government we should dare to try and take away the free ride some have been on for years,families who have 3rd generations still on the system,illegals with the help of advocasy groups helping them get on the system,we have no voice,we just keep paying for their life of free social system benefits,the elephant in the room all fear of confronting.

  • muggs May 23, 2:26 p.m.

    bhughesnc,"Where is the person that has the guts to tackle this issue?" The answer to that question was put before us and he was ignored,Ron Paul.

  • bhughesnc May 23, 1:58 p.m.

    All social programs are corrupted by political influence When the majority in this state is on some sort of state assistance how would even the most devoted conservative ever get elected. Even us hard working, tax paying citizens have someone they love on some social program that we feel they deserve and cannot do without. We also probably know someone that is milking the system like my ex-son-in-law that is on social security disability and makes what would be a middle class living working on cars with pay under the table, or my 40 year old niece who has never had a public job, with 3 children. She sells her food stamps to buy cigarettes and by the way she is on the state's methadone program permanently.

    Where is the person that has the guts to tackle this issue?
    When are we going to realize that "tough love" really works?

  • muggs May 23, 1:10 p.m.

    rebelbelle, I really did not know that being poor could be such a lucrative means of making money,your information on the amount of funding one can get has really made me wonder when we will kick these pirhana to the curb,take away their decades of benefits and let them sleep in the streets if they choose to do so,a drive through,if you dare,into any of these government projects will exspose who and what group is reaping the most from being what they are,discrimination at it's best,200 years of mooching is more like it.

  • rebelbelle May 23, 12:45 p.m.

    loveapex--do you REALLY want to subject your grandmother to random drug testing? Social Security is a government program.

    What is needed is a total overhaul of assistance programs for the "poor". Did you know that a welfare family can get $35,000 or so a year in cash and benefits like subsidized housing, food stamps and medical assistance--including a free cell phone!

    Medicaid fraud is the tip of the iceberg. What about six generations in subsidized housing? What is the incentive to get off welfare programs when you receive a "middle class" income tax free?

  • muggs May 23, 12:31 p.m.

    The offerings of so many solutions will fall on deaf ears,this is a problem that will result in some political party standing up and taking the beating they will receive for taking the free food,free housing,free medical and a host of other benefits going to a those that although not bound together by ethnic association but by class association,the advocates for these groups who are not responsible for the cost of all these free programs will be out in force trying to vilify any that stand up to their demands,we know who these groups are and they have gained power through voter intimidation,we have no one advocating for us at the present time,maybe soon I hope.

  • babsd24 May 23, 11:39 a.m.

    Yes each person applying for medicaid should be drug tested and tested again randomly. Also each person/family on medicaid and other assistance such as food stamps and disability should have to turn in medical testing often, and if they are just out of work for whatever reason they should have only a certain amount of time to receive assistance. The longer they are allowed help the longer they will put off getting a job, but rest assured they are working and being paid under the table.

  • Nancy May 23, 11:11 a.m.

    A blast from the past .... January 2012

    "Lanier Cansler, head of the state Department of Health and Human Services, is leaving the department at the end of the month.

    [snip]

    In a prepared statement, Cansler praised Perdue's leadership.

    "We cut spending, eliminated waste and consolidated agencies - all to make state government more efficient without neglecting our core mission of serving the people," the statement said.

    Cansler, appointed in 2009, led the state's largest department during a challenging time. Medicaid, the government health insurance program for the poor and disabled, has a $149 million budget gap this year, and next year's budget hole is projected to be larger.

    Read more here: http://www.newsobserver.com/2012/01/14/1776712/health-agency-head-resigns.html#storylink=cpy

  • loveapex May 23, 11:02 a.m.

    How about this novel idea, lets have drug testing for anyone on medicaid, food stamps, WIC, disability or receiving a government paycheck? Senators, representatives, etc. A test to come on board and then random testing. We know all the arguments for it, lets make this happen. We could really free up some money.

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