Durham agency denied Medicaid money after 'allegation of fraud'

Records show N.C. Behavioral Health billed Medicaid for more than $712,000 in counseling services in 2011, including 3,237 therapy sessions for a total of 7,920 hours. That’s nearly 22 hours a day, every day of the year, all billed in the name of one psychologist, Eunice Ngumba-Gatabaki

In May, the WRAL Investigates team reported on Medicaid billing attributed to Gatabaki through Rehoboth Consulting in Raleigh, which averaged about 60 hours a day and cost the state about $1.79 million. Through her attorney, the psychologist says she simply reviewed progress notes and advised other therapists for the agency.

DHHS rules dictate the billing name must be the actual counselor providing service.

As for N.C. Behavioral Health, Gatabaki says she has never heard of the agency and is angry and concerned that the business used her provider number for all of its Medicaid billing. She has offered to cooperate fully with any investigation, Shaber said. In the meantime, the state is reviewing all of her billing.

N.C. Behavioral Health registered agent and Chief Executive Tracie Clay declined to comment.

DHHS Secretary Al Delia said he can’t talk about specific provider cases but said his department is “coming after people very quickly and very aggressively.”

“There are spider webs of connections among providers and among people who make referrals to providers. So, when we find one, we generally find more than one. It's kind of like cockroaches,” Delia said.

To date, DHHS has referred 35 cases totaling about $21 million to the special Medicaid Investigations Unit of the Attorney General’s Office for criminal investigation.

Thirteen of the referred providers were in Wake County, four in Durham, three in Robeson and two in New Hanover. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland, according to DHHS.

“Not only have we referred more of these cases than in the past, they have accepted a far higher percentage of those cases. It's a very high percentage of those cases for criminal investigation,” Delia said.

Last year, North Carolina spent about $10 billion on taxpayer-funded Medicaid claims, covering everything from doctors’ bills to mental health care for low-income residents.

DHHS leaders say they can’t manually verify all 88 million claims each year, so they have turned to a new fraud detection computer program from IBM. The program uses math and statistics to find abnormalities in Medicaid claims, and North Carolina is the first and only state in the country using it.