WILMINGTON, NC (WECT) - We've all had long days at work, but a Wilmington Medicaid provider claims she worked 78 hours in a single day, providing mental health counseling to patients.
Ahada Jones helped people with drug, alcohol and other mental health problems. She saw patients who can't afford insurance, so the state pays the services for them.
The state paid Jones generously for those impossibly long days. In some cases during a six month stint starting in September 2011, Jones got more than a $100 thousand a month. Taxpayer money.
Jones has now been flagged by the state, as they try to recoup money they've overpaid. Unfortunately, this is not an isolated case. Tens of millions of dollars have been lost to Medicaid abuse across the state.
A few examples of suspicious billing in our viewing area:
Johnson is being asked to repay the state $122,875
Auditors say they found mistakes in her patient charts including:
Lack of a referral form from an approved provider source
Lack of documentation for service provided
Service notes lack specific treatment goal
When we called Ms. Croteau Johnson for an explanation, she failed to return our call. When we went to her office in person, she said she couldn't talk to us because she was counseling patients. We again gave her our number, but she never called us back.
Eastern Psychiatric Assoc, PA Former location: 3807 Peachtree Ave, Suite 101, Wilmington Current location: 4320 Wrightsville Ave, Suite B, Wilmington
Provider associated with this address: Dr. Steven Bentsen, MD
Eastern Psychiatric Associates is being asked to repay the state $43,902
Auditors say provider failed to submit medical records to support dates of service billed.
Almost every time we called this office, we got an answering machine, and no return phone call responding to our message. We also visited Eastern Psychiatric Associates twice in person during regular business hours. Dr. Bensten wasn't there either time. The woman at the front desk said he doesn't talk to the press. She refused to tell us what his office hours were, or when the last time was that he was in the office.
MQA Support Services/Ahada Jones 4016 Shipyard Blvd (office now vacant)
This provider has been put on prepayment review by the state
Total paid for 6 month stint beginning in September 2011: $396,012
State paid $116,925 for 1619 hours of service in November 2011
State paid $110,657 for 1450 hours of service in December 2011
Officials at DHHS are not sure where Jones is now. They referred us to the website of a Texas mental health practice, where she appears to be working now.
North Carolina is in the midst of a Medicaid fraud crackdown, and has begun identifying and prosecuting suspected cases of Medicaid fraud. Last year, the NC Attorney General recovered almost $100 million from suspected Medicaid abusers through dozens of criminal convictions and civil settlements.
But for providers like Ahada Jones, who appears to have left the state, your tax money may be harder to recover. "Everyone wants us to get the people that are doing wrong, and we do too," said NC Medicaid Director Carol Steckel. "But we have to follow the due process, and that is…cumbersome."
This has been an extremely difficult story to tell. Getting the billing data from the state, and getting answers to our follow up questions about what exactly the state paid for, has taken almost a year.
The data is complicated and can be confusing to interpret - even for the people who work in the Medicaid office. The convoluted nature of the billing and the sheer volume of the $13 billion in services Medicaid pays for in North Carolina each year give you some idea of how fraudsters have been able to go undetected in the past.
Friday, April 18 2014 3:30 PM EDT2014-04-18 19:30:10 GMT
NEW HANOVER COUNTY, NC (WECT) – After an arrest, everything including a person's nutritional, medical and safety needs are now the responsibility of the New Hanover County Detention Facility. In lightMore >>
The jail is prioritizing a new project to cut down on attempted suicides and injuries with a steel shield.More >>
Tuesday, April 15 2014 10:52 AM EDT2014-04-15 14:52:21 GMT
COLUMBUS COUNTY, NC (WECT) - When you think about generic prescription drugs, you probably think bargain prices. But in recent months, the wholesale cost of dozens of generic drugs has been skyrocketing,More >>
In recent months, the wholesale cost of dozens of generic drugs has been skyrocketing, and it's putting pharmacies and patients in a pinch.More >>
Monday, April 14 2014 7:34 AM EDT2014-04-14 11:34:23 GMT
PENDER COUNTY, NC (WECT) – Six years ago, Vickie Gallop was killed in a hit and run. Who hit her remains a mystery. Now, another tragedy in her family has her sister renewing her push for answers in anMore >>
Six years ago, Vickie Gallop was killed in a hit and run. Who hit her remains a mystery.More >>
Thursday, April 10 2014 9:26 AM EDT2014-04-10 13:26:45 GMT
A wooded area at a truck stop on Interstate 20 in Darlington County was a crime scene 14 years ago when a woman's body was discovered. For more than a decade, this woman lay in a Darlington County cemeteryMore >>
A wooded area at a truck stop on Interstate 20 in Darlington County was a crime scene 14 years ago when a woman's body was discovered. For more than a decade, this woman lay in a Darlington County cemetery without anyone knowing her name.More >>
Wednesday, April 2 2014 4:00 PM EDT2014-04-02 20:00:42 GMT
WILMINGTON, NC (WECT) – About 3 minutes. That's how much time New Hanover County grand jurors typically spend weighing the facts of a case before voting to indict a suspect on felony charges. And theyMore >>
Defense attorneys say grand juries are no longer working the way they were intended, and former jurors question the point of the process.More >>
322 Shipyard Boulevard
Wilmington, NC 28412
Main Phone Number: (910) 791-8070
Newsroom: (910) 791-6681