WRAL Investigates

Letter prompts state Medicaid fraud investigation

Posted May 11, 2010
Updated May 13, 2010

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— A letter from a home health care provider that appears to coach clients on how to appear needy has state investigators on alert for possible fraud.

Oasis Home Care Services Inc. owner Doris Williams recently sent a letter to her company's 62 clients, warning that nurses from the state Division of Medical Assistance would be assessing people to determine if they still qualified for in-home aid.

"I advise you to please be aware they are not your friend and are looking for ways to cut your hours because of the state budget," Williams wrote in the letter. "You must not do anything to hinder your services. For example, if you have a walker, wheelchair or cane, please be using it while the state RN is at your home."

Doris Williams, owner of Oasis Home Care Services Home health agency owner defends client letter

The letter instructs people to tell the nurse they "really need the services and the hours you already get" and that Oasis should be the agency to provide those services.

"Please don't tell the state RN that you (bathe) yourself or prepare your own meals because this will disqualify you for (in-home personal care) services," the letter concludes.

Gov. Beverly Perdue's proposed budget, which includes cutting about $386 million in state Department of Health and Human Services spending, recommends eliminating the Personal Care Services program and creating a new one for adults with the most severe needs.

"My personal reaction is it makes me mad," Perdue said after reading the letter. "What she's doing is saying, 'Scam the system. Pull out the walkers and the canes, and act like you're really bad off.'"

Medicaid fraud investigators from the state Attorney General's Office immediately visited Oasis to check up on its operations.

Williams said Tuesday that she regrets sending the letter, but she maintained that she was just trying to make her elderly clients take assessments seriously.

"People read into a lot of things, and you know, all I can do is clarify what my intentions was, and I have pure intentions," she said. "I have no intentions of committing fraud.

"The clients that we serve really need the services," she said.

Eighty-eight-year-old Godfrey Green, for example, receives in-home care from Oasis for 11 hours a week. Certified nursing assistant Pattie Ricks cooks for him, bathes him and tidies up his apartment, and Medicaid pays Oasis $750 a month for the service.

Without the service, Green said, he would "go ahead and die."

Perdue said she wants a fair and efficient system, not a ban of home health care. She said she believes majority of home health care clients legitimately need the services, but she wants Medicaid fraud investigators to weed out those who don't.

Her proposed budget includes $35 million in savings from cracking down on Medicaid fraud and waste.

"I believe services should only be prescribed for people who need them, that the medical provider and the medical caregiver both need to be held accountable," she said.

43 Comments

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  • mountainlover May 13, 2010

    I agree with the commenter who stated that any medicaid fraud investigation should be on the other end of the spectrum--on the breeders, the young, and the able bodied. This is where the REAL fraud is going on. It is going to take a lot more resources to pay to kept the elderly in a nursing home. Those costs run in the neighborhood of $200 per day.

  • almagayle50 May 13, 2010

    How much of the $750 goes to Oasis? It's my experience that the provider agency/bill through agency gets a a great deal of the money. Oasis is probably not protecting it's clients, but it's own income.

  • annettelewis79 May 12, 2010

    Why doesn't BEV PERDUE or WRAL investigate WHITE COLLAR CRIME COMPANIES, (PHYSICIANS, HOSPITALS, MEDICAL BILLING COMPANIES)? I have been a medical biller for 25 years, I know what they do, they collect millions of dollars by fraud, year after year, and no one does anything about it, because they all stick together!!!!!!

  • annettelewis79 May 12, 2010

    I have worked as a Medical Biller in this area for 25 years, I know for a fact that providers and medical billing companies use many tactics to gain profit from Medicare, Medicaid and other third party payors. I feel that this incident was isolated and that this company was not committing fraud. I was recently fired from a Medical Billing Company because I uncovered millions of dollars of fraudulant billing, billing Medicare twice, billing for wrong dates, billing two insurance companies and keeping the money, receiving payment from both the insurance company and patients and not refunding the money, this constitutes fraud, unfortunately NC govenment officials, lobbyists, physicians and large corporations stick together to make a profit. I have informed the NC Employment Security Commission of the fraudulant billing several times, but because this company has money and has high paying lawyers and connections, my unemployment has been denied. Why did WRAL decide to pick on a small compa

  • Boostershot May 12, 2010

    Rocky Mount makes WRAL news at least 2-3 times a week now..and it's not good news either. No wonder Tom Suiter wanted off the air. Sorry Tom, that you have to tell people that Rocky Mount is your hometown. Rocky Mount...down the tubes again.

  • methinkthis May 12, 2010

    That this is going on is no surprise. There is a large group of people, way too large a group of people, who have this concept that we are all playing a game. The objective is to get money from the 'guvmnt'. I exist therefore it is owed me. They have absolutely no concept of where the money actually comes from or they think that Gates, Buffet, Walton's et all are the only ones paying taxes. There should be provision for those who really need help. Whether it is food stamps, medicaid, handicap parking sticker, etc. no one should be allowed to abuse. These ads on TV for diabetes supplies or scooters should be banned. THEY ARE NOT FREE! Taxpayers are paying for them. There is a horrendous amount of fraud in the medicare and medicaid systems now. It needs to be stopped before we add a new set of entitled people.

  • Dollars-and-Sense May 12, 2010

    I believe this matter warrants an investigation by Medicaid Fraud investigators, but I believe in the end they'll find no fraud...just a poorly worded letter from an owner concerned about losing funding. Medicaid Fraud investigators tend to go after the 'low hanging fruit'. The big fraud perpetrators out there (company owners) are investigated as well, but they can afford the high dollar attorneys to successfully defend them.

  • affirmativediversity May 12, 2010

    Why does Bev and the Dem's constantly pick on the disabled and old people? It's pretty much come down to bullying, if you ask me!

    Where was all Bev's "I'm mad" righteous indignation when Tony Rand was shaking down private companies or when Mary Easley was collecting a six figure salary from UNC for nadda or when her buddy was giving his employees bonuses so they could contribute to her campaign?

    Why did that make you "mad" Bev?

  • Seenenuff May 12, 2010

    The letter was poorly worded and ill-conceived. I am not convinced this woman is committing fraud but has the best interest of her clients at heart. Most people who are involved in this type of fraud usually don'tagree to TV interviews.

  • cocker_mom May 12, 2010

    Working with the elderly isn't easy. If Oasis's clients get the in home care they need, and visits billed are actually performed - then I can't see the fraud here.

    If her clients are healthy and looked after - then let them keep the care.

    Like many others here - I don't see this as a big fraud area - there were certainly folks that DID defraud the government with billing for that weird "community care" program, but this does not appear to be that.

    And yes - there's a ton more Medicaid / SSI / disability fraud going on by the young and able bodied. Let's focus there.

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