Mental Health Provider Charged with 16 Felony Counts

A Vance County mental health provider has been arrested and charged with 16 felony counts related to Medicaid fraud. Bobby Faison, 41, a counselor with Prodigious Health Services, faces charges including medical assistance provider fraud, offering kickbacks and obtaining property by false pretenses, according to the office of Attorney General Roy Cooper. The arrest followed an investigation by the attorney general's Medicaid Investigations Division. The investigation was prompted by a tip from a Medicaid recipient that Prodigious had made Medicaid billings using her family's Medicaid recipient even though they had not received any services. Investigators say the scheme uncovered showed that Medicaid recipients were offered payment of utility bills and toys for their children in exchange for filling out forms revealing their Medicaid recipient numbers. Faison is alleged to have obtained or attempted to have obtained $103,075 through fraudulent claims. "Ripping off Medicaid wastes taxpayer money, hurts needy patients, and drives up health care costs," Cooper said. "Those who cheat Medicaid should expect to pay the price."(THE INSIDER, 9/12/12).

State Legislators Questioning Benefits of DHHS Contract

State legislators took another look at state contracts designed to catch fraud and create savings in the Medicaid program, questioning whether the state would see a return on its investment. Members of the Legislative Oversight Committee for Health and Human Services on Tuesday repeatedly expressed frustration about the lack of details coming from the executive branch about why contracts given to IBM, SAS and Public Consulting Group weren't more iron-clad in guaranteeing savings. A state audit earlier this summer found that the contracts, focused on using computer software to detect fraud, were costing far more than they were returning in savings. "I will tell you, in the private sector, if I drew up a contract like this for a client, I wouldn't have that client," said Sen. Doug Berger, D-Franklin. Al Delia, acting secretary of the Department of Health and Human Services, said that he, as secretary, was ultimately responsible. Both he and state Medicaid director Michael Watson urged legislators to be patient. Watson said state officials consider the program part of a five-year effort to detect and catch Medicaid fraud. "I think at the end of that time period, we are going to be very comfortable with where we are," he said. The IBM and SAS contracts were entered into in 2010. A fourth contract, entered into earlier and held by Health Management Systems, has led to $158 million in recovered money, at a cost of $14.9 million to the state, according to the audit.(THE INSIDER, 9/12/12).

Medicaid in the News

Costs soar as a 500-plus team of workers from a Virginia based computer science company come together to update North Carolina's Medicaid computer system.  This overhaul makes up one of North Carolina's largest contracts and is scheduled to be complete by this time next year.  To read more about this story, click here.

NCDMH Developmental Disabilities and Substance Abuse Services Implementation Updates

The North Carolina Department of Mental Health Developmental Disabilities and Substance Abuse Services has recently issued a list of Enhanced Services Implementation Updates.  For a list of the updates and more information, click here!

Wake and Durham Work Together to Create HMO

Wake County Alcoholic Beverage Control board is giving $2 million to Wake County to help with the start up of a HMO.  Wake County and Durham County are agreeing to start the HMO in order to create a new organization to handle behavioral-health programs paid for by medicaid.  For more information on this issue check out the link here!

Legislators and DHHS Planning fo Medicaid Cutoff Deadling

With a medicaid funding deadline approaching, legislators are getting together with the Department of Health and Human Services to plan for the possible $414 million dollars NC could lose in federal funding.  Check out the link for more information here.

NC State Plan

The N.C. Division of Vocational Rehabilitation Services is responsible for the general state vocational rehab services program and the state-supported employment services program.  The Rehabilitation Act of 1973 requires each state VR program to submit an annual state plan outlining how it will comply with the act.  Check out N.C.'s State Plan here!