WRAL Investigates

Durham agency denied Medicaid money after 'allegation of fraud'

Posted July 25, 2012

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— Two months after the WRAL Investigates team reported on nearly $200 million in possible Medicaid fraud in North Carolina, records show another Triangle company may have excessively billed the state for Medicaid claims.

The state Department of Health and Human Services shut off Medicaid funding for North Carolina Behavioral Health & Counseling Services last month, citing "a credible allegation of fraud." The Durham-based business was one of more than 200 agencies flagged by the state's new computer software that is designed to catch questionable billing.

Records show N.C. Behavioral Health billed Medicaid for more than $712,000 in counseling services in 2011, including 3,237 therapy sessions for a total of 7,920 hours. That’s nearly 22 hours a day, every day of the year, all billed in the name of one psychologist, Eunice Ngumba-Gatabaki

In May, the WRAL Investigates team reported on Medicaid billing attributed to Gatabaki through Rehoboth Consulting in Raleigh, which averaged about 60 hours a day and cost the state about $1.79 million. Through her attorney, the psychologist says she simply reviewed progress notes and advised other therapists for the agency.

DHHS rules dictate the billing name must be the actual counselor providing service.

"Rehoboth Consulting Agency did the billing, and she thought the billing was being done correctly,” Steve Shaber, Gatabaki’s attorney, said in a July 23 statement. “Any suggestion that she knowingly billed improperly, or knowingly helped others bill improperly, is wrong."

As for N.C. Behavioral Health, Gatabaki says she has never heard of the agency and is angry and concerned that the business used her provider number for all of its Medicaid billing. She has offered to cooperate fully with any investigation, Shaber said. In the meantime, the state is reviewing all of her billing.

N.C. Behavioral Health registered agent and Chief Executive Tracie Clay declined to comment.

Medicaid fraud Durham agency accused of Medicaid fraud

DHHS Secretary Al Delia said he can’t talk about specific provider cases but said his department is “coming after people very quickly and very aggressively.”

“There are spider webs of connections among providers and among people who make referrals to providers. So, when we find one, we generally find more than one. It's kind of like cockroaches,” Delia said.

To date, DHHS has referred 35 cases totaling about $21 million to the special Medicaid Investigations Unit of the Attorney General’s Office for criminal investigation.

Thirteen of the referred providers were in Wake County, four in Durham, three in Robeson and two in New Hanover. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland, according to DHHS.

“Not only have we referred more of these cases than in the past, they have accepted a far higher percentage of those cases. It's a very high percentage of those cases for criminal investigation,” Delia said.

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.

DHHS leaders say they can’t manually verify all 88 million claims each year, so they have turned to a new fraud detection computer program from IBM. The program uses math and statistics to find abnormalities in Medicaid claims, and North Carolina is the first and only state in the country using it.


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

15 Comments

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  • clp9158 Jul 26, 6:28 p.m.

    Anyone can login to the website and gEt a doctor's NPI number allowing them to bill Medicaid. Unfortunately, it is happening all over the state and innocent people and agencies are being punished.

  • stevee2 Jul 26, 11:59 a.m.

    That lady must be one heck of a phychologist!

  • storchheim Jul 26, 11:20 a.m.

    wmanderson is correct. We paid for the drones, shouldn't we have a say in how they're used?

  • storchheim Jul 26, 11:20 a.m.

    muggs, unfortunately, the rules invite abuse by saying that bling and accessories do not count as assets. You're allowed a house and a car and $2000. TVs, jewelry, cell phones and the like can't be considered. They do "try" to determine citizenship but only after benefits are received. No doubt the fine upstanding illegals who just want a better life for TheChildren show up for their ICE hearings each and every time, and pay back any monies they stole.

  • williamanderson27607 Jul 26, 8:51 a.m.

    Since we are moving ever closer to a "police state", fraud in entitlement programs. Medicaid and Disability would be a great place to go "whole hog". EPA is using drones to observe livestock fecal run off, but money would be better spent on these areas. You can throw in defense contractors and government employee expense accounts. Might as well lighten the financial load as we are marched into the gulags!

  • muggs Jul 26, 8:50 a.m.

    I see this system being abused evey time I visit my doctors office, if you are to be held to a certain level of monitary resources before being eligble how is it many of these people seem to be pretty well off, nice vehicles, dressed nice, cell phones, wearing jewelry, not what you would exspect of a person who is in need, young Hispanic, non english speaking women, toting two or three children, illegal or not I have no idea, it is a question that is not allowed to be asked, we have Whites doing the same, so it's not just anyone group.

  • aetius476 Jul 26, 8:45 a.m.

    Good luck in expanding the fraud ridden Medicaid system by over 35% by 2014. With the level of theft, fraud, and incompitence now being experience that should be a real money saver for the taxpayer!

    The whole scam is a transfer of payments scheme to those connected and knowing how to work the system. All being sold to the gullible taxpaying public as "help for the disadvantaged, etc".

    The sheep no longer even know their being fleeced!...

  • whatelseisnew Jul 26, 8:43 a.m.

    "We haven't seen anything yet - wait until the rolls on Medicaid go through the roof with the fed health deal - they can't handle what they have now and don't seem to want to."

    I am hoping that North Carolina will not be so stupid as to agree to expand the Medicaid program.

  • whatelseisnew Jul 26, 8:42 a.m.

    Reason number 9 million and 1 why Medicaid and Medicare and now ObamaCare should not exist.

  • tiredofgovtwaste Jul 25, 7:52 p.m.

    "Funny that the government will not take on the hospitals and bigger med organization, who they know comitt fraud. Sherlock"

    Trust me, hospitals have and will continue to be monitored and audited, the system has been there. It's just that the govt now has a system to track those who have hid behind the "small business" cloak and are now being caught. These business need to be shut down, repayment be required and JAIL time for these crooks of yours and mine tax dollars.

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