Raleigh, N.C. — Less than a year after the state suspended a Raleigh business for questionable Medicaid billing, the WRAL Investigates team has learned that the business changed its name and continued operating undetected by the state.
Last May, the state Department of Health and Human Services suspended Rehoboth Counseling & Consulting Agency’s Medicaid payments because the department determined "a credible allegation of fraud exists for which an investigation is pending."
Out of $1.3 million in taxpayer money spent, DHHS records showed psychologist Eunice Gatabaki accounted for the bulk, working an average of 60 hours per day. Her daily average increased in June 2011, as records show she worked more than 100 hours per day for 17 days.
Through her attorney, Gatabaki said Rehoboth handled the billing and that she merely signed off on other counselors' work.
Not long after WRAL Investigates’ story aired on May 21, 2012, the old Rehoboth sign was gone, and a new one – “Optima” – took its place. WRAL called the state about the new company, but there was no record of its existence.
Three weeks ago, with the Optima sign still in place, the WRAL Investigates team found a new company listed in the Secretary of State’s records at the very same address on Garner Road, providing the same services, this time as “Ultimate Contracting Services.”
The registered agent, Brendora King, and one of the members, Lisa King-Hodge, are the same women who ran the now-defunct Rehoboth Counseling & Consulting Agency. WRAL Investigates tried contacting Ultimate Contracting Services in person, by email and phone, but no one responded.
WRAL Investigates notified DHHS on Feb. 6 about the company and, within two weeks, the state visited Ultimate’s office and opened an investigation.
New billing records show Ultimate collected money from April through May 19 last year. WRAL’s story aired two days later, and Ultimate took a two-month break from billing before starting up again. In all, Ultimate brought in $1.2 million in Medicaid money.
Compared with Rehoboth’s records, the hours worked by individual counselors each day for Ultimate appeared to be reasonable, and Gatabaki was not included in the new company’s billing. However, Ultimate's application with the state raised some questions.
img src="https://wwwcache.wral.com/asset/news/local/wral_investigates/2013/02/26/12156091/3840-cullen-220x165.jpg" width="120" height="90" alt="Raleigh business changes name, keeps collecting Medicaid"">Raleigh business changes name, keeps collecting Medicaid
The owner is listed as Marcellin Daniel Hodge, the husband of King-Hodge, who owned Rehoboth. The provider background check looked for Marcellin Hodge’s name, the name of the new company and the employer identification number to see if the company had done business with the state in the past. All three checks came up clear.
Despite having the ability to search the business address, the records WRAL Investigates received show that didn’t happen. Both companies listed 1500 Garner Road, Suite A, as their place of business.
Also in the application, when asked if the new company was forming due to a change of ownership, merger or acquisition, the answer “No” was circled. When asked if they had ever been a Medicaid provider before, they also circled "No." However, every therapist listed on Ultimate’s billing records is also listed on Rehoboth’s billing statements.
State Rep. Nelson Dollar, R-Wake, says software already helping to identify suspicious billing should have caught the change.
“They shouldn't be able to do this and come right back at taxpayers and start milking them for money under another name,” he said. “We need to make sure that bad providers, which is only a small number, bad providers are put out of business permanently … We simply don't have the extra money in this state to be able to run our Medicaid system with $100 or $200 million in fraud.”
DHHS has referred dozens of cases to the state Attorney General's office for possible prosecution, but neither agency will comment on where those investigations stand. DHHS spokeswoman Julie Henry released a statement Tuesday afternoon, saying the department's No. 1 priority is "reforming Medicaid to ensure money is being spent on services for those who need it most."
"Any dollar that is misspent in Medicaid, whether through mismanagement or through fraudulent billing, is one less dollar to help the individuals and families we serve," Henry added.
Source : http://www.wral.com/suspended-raleigh-business-changes-name-keeps-collecting-medicaid/12155050/798