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Medicare and Medicaid Fraud Unfolds in North Carolina

An investigation of Medicare and Medicaid fraud continues to net cheats draining resources from the two government programs. One of the sweeps for fraudsters, which started in December 2011 and is ongoing today, has rounded up dozens of criminals.

Among the more outrageous arrests is that of a Wake County licensed therapist who is said to have charged for 23,000 hours for a year’s worth of therapy with her clients. There are 8,660 hours in a year. The billing records of psychologist Eunice Ngumba-Gatabaki indicated her average work day was 60 hours. The cost to the state of North Carolina was $7.9 million.

Last year the therapist billed for 100 hours per day over a 17-day period. She told WRAL News that some of her bills may have been “billed under my provider number that may be attributable to other licensed providers.”

“Those are dollars that aren’t there to treat older sick people or children,” said Governor Bev Perdue.

The therapist’s name also was tied to more than $676,000 in Medicaid billing by North Carolina Behavioral Health and Counseling. She denied being connected to the agency. North Carolina paid out approximately $10 billion on Medicare claims. North Carolina became the only state in the nation to institute a new IBM investigative mathematics and statistical program to help catch illegal billers.

In its first several months a new crackdown in January 2012 on Medicaid fraud resulted in 20 arrests and 17 convictions. Dozens have been convicted since then and the investigations continue to turn up more cheats.

Those arrested include:

  • dentists
  • Physicians
  • home health care workers
  • Psychologists
  • An HIV case manager
  • Hospice care workers
  • Rehabilitation employees
  • People getting kickbacks for medical equipment such as wheelchairs and beds
  • Nursing home workers
  • Assisted living caregivers
  • Ambulance service personnel
  • Medical coders who under doctors’ or nurses’ orders illegally change billing codes
  • Long-term care facility workers

The Medical Investigation Division in the State Attorney General’s office nearly doubled in size within the last couple of years, leading to more arrests, convictions, restitution to the state in fines and prison time.

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