Monday, April 29 2013 10:08 PM EDT2013-04-30 02:08:09 GMT
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 helpedMore >>
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.More >>
Tuesday, April 30 2013 10:00 PM EDT2013-05-01 02:00:13 GMT
WILMINGTON, NC (WECT) – Thousands and thousands of dollars are paid each year to people who provide Medicaid services in our region. North Carolina is in the midst of a Medicaid fraud crackdown, and hasMore >>
The state has obtained criminal convictions against some Medicaid fraudsters, while others are under review. Dr. Tom Matthew is one of those providers and says he's done nothing wrong. In fact, he says it's the worst thing that has ever happened in his professional career.More >>
WILMINGTON, NC (WECT) – Some local Medicaid providers are furious with the state. They say a private company hired by the Department of Health and Human Services to conduct an audit of Medicaid providers botched the job, wrongly accusing legitimate providers of over billing.
Nicole Croteau-Johnson is one of the Wilmington Medicaid providers flagged by auditors for over billing. She initially declined our request for an interview, but is now trying to set the record straight.
Auditors originally claimed Croteau-Johnson over billed Medicaid by $122,000 - but the state drastically reduced that amount after a recent appeal. Records show the state is now seeking to recoup just $1,700 because Croteau-Johnson failed to sign one patient chart, and used the wrong billing code on several others.
Attorney Don Evans represented Ms. Croteau-Johnson and 9 other local Medicaid providers who have received over billing notices from the state. In every case, Evans says he was able to prove the auditors were wrong, and the amount his clients were asked to repay was reduced to nothing or almost nothing.
But the damage was done. Evans says the disruption, embarrassment and legal expenses resulting from these botched audits just isn't worth the trouble. As a result, all 10 of Evans' clients have now dropped their Medicaid patients.
And it gets worse. Dr. Steven Bensten was asked to repay $43,900 for failing to provide auditors with patient charts to support services billed to the state. Bensten's attorney now tells us the state never even audited his practice before sending out that notice in error.
Mental health counselor Ahada Jones has also taken issue with the audit. She used to work for MQA Support Services on Shipyard Blvd., but was put on prepayment review after auditors uncovered records indicating she billed the state 400 thousand dollars for just 6 months of work counseling Medicaid patients.
Ms. Jones now tells us she didn't do any of that work. She says she quit her job with MQA Support Services just before the flagged billing began. Jones believes someone at her former place of work fraudulently used her provider ID number to bill the state for patient exams that never happened.
DHHS provided us with the over billing notices for these providers shortly before our story aired - but they did not give us details about what had been transpiring during the appeals process.
Because the providers in question initially refused to talk to us, it made it difficult to tell their side of the story. Now that they have - we have contacted the state again, and we are waiting for a response to why so many of these providers say they've been wrongly accused.
Also of note, there are many more local providers who have been flagged for alleged over billing than the state initially told us. Don Evans personally has represented 10 of them in the last two years.
There is also an update on a local case handled by attorney Steve Coggins. He represented Trinity Wellness Center when the state claimed the Wilmington mental health provider had over billed Medicaid by $368,000.
Coggins tells us he just got a call from the Assistant Attorney General informing him that the state Medicaid office is expected to drop the entire case against Trinity, except for 3 no-shows that were accidentally billed. He says Trinity has always been willing to repay the state for those visits.
The State Auditor has expressed concerns about the way Medicaid has handled its recent audit. Specifically - with paying 3rd party auditors so they had a financial incentive to find errors in providers' charts.
73 percent of the medical practices that were initially flagged for overpayment appealed those findings, and the State Auditor's office tells us that high percentage of appeals indicates a problem with the audit process itself.
The State Auditor's office says Medicaid officials have been receptive to suggestions about improving the auditing process moving forward. A follow up audit of Medicaid in a couple of years may be performed to ensure these suggested improvements have actually been implemented.