MEDICAID FRAUD CRACKDOWN: Local providers under review

Published: Apr. 29, 2013 at 2:49 PM EDT|Updated: Jul. 8, 2015 at 8:15 AM EDT
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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.

Nicole Croteau-Johnson, LPA
411 Chestnut Street, Wilmington

  • 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.

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