WRAL Investigates

Letter prompts state Medicaid fraud investigation

Posted May 11, 2010 6:15 p.m. EDT
Updated May 13, 2010 3:11 p.m. EDT

— 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."

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.