W. TERRY SMITH
One of the candidates challenging state Sen. Clark Jenkins in the upcoming Primary Election overcharged the state more than $5.5 million for claims in Medicaid reimbursement, according to state Department of Health and Human Services documents.
Cambridge Behavioral Health Services, which has offices in Rocky Mount and Greenville, is owned and operated by Frankie and his wife Hattie Faye Bordeaux of Greenville. Frankie Bordeaux is one of two Democrats opposing Jenkins in the May 4 primary. Jenkins, a Tarboro businessman, is seeking a fifth term.
According to an agreement the Bordeaux’s negotiated with the state Department of Health and Human Services, Division of Medical Assistance, they must repay $4.2 million.
Cambridge has 24 months beginning this month to refund the money or be shut down and have to pay a total of more than $5.5 million for $4,796,099 in Community Supports claims paid from July 1, 2008 to Dec. 31, 2008 and $771,157 for non-Community Support Services claims paid from July 1, 2008 to Dec. 31, 2008
That’s the agreement signed Feb. 24 by both Bordeaux's and each “acknowledge and agree to be personally liable and bound by the terms, obligations and provisions of this agreement.”
The findings appear criminal and have been referred to the state Attorney General’s Office, however a spokeswoman with the state Attorney General’s office said, “We can neither confirm or deny there is investigation.”
"We are facing severe cuts in the budget, including the Department of Health and Human Services," Jenkins said. "That will result in day care providers being able to care for less children. Some working mothers will have to quit working to care for their children. That's very troubling."
In addition, Cambridge has 90 days to achieve a 75 percent clean claims date or it “shall be shut down immediately,” the agreement states.
Cambridge cannot apply for enrollment to provide any N.C. Medicaid service until each and every Cambridge site achieves a 93 percent clean claims rate for three consecutive months.
The findings stemming from “a comprehensive investigation and total systems review” include:
• 98 records lacked valid authorization or had no authorizations.
• 150 records lacked valid service orders or had not service orders.
• 195 records lacked valid person-centered plans or had no person-centered plans.
• 80 records do not have documentation written and signed by the person who delivered the service.
• 366 records did not have documentation that the staff is qualified for the service provided.
• 244 records did not have service notes related to the individual goals in the person-centered plan.
• 428 consumers served at the Medicaid providers three unauthorized sites had service billed and paid under the provider number assigned to the Greenville site.
Also, “there were several incidences of potential fraud, including suspected forged and taped signature on a person-centered plan, numerous duplicate or “canned” notes, and unqualified staff who delivered service and your Medicaid overpayment in the amount of $5,567,257,” stated a Sept. 29, 2009 certified letter to Hattie Faye Bordeaux from Patrick O. Piggott, chief, Behavioral Review Section, Program Integrity, North Carolina Department of Health and Human Services, Division of Medical Assistance.
"I read where Mr. Bordeaux said this was a routine audit," Jenkins said. "The audit may have been routine, but the findings certainly weren't: 1,500 errors, a 90 percent error rate."
The Cambridge offices are at 622 S. Memorial Drive in Greenville and 132 N. Englewood Drive, 3023 Zebulon Road and 3204 Sunset Ave. in Rocky Mount.
The Bordeaux couple was unavailable for comment this morning. She is the clincal director. He is the administrative chief.
Replying to an earlier report last week in the Rocky Mount Telegram with a letter to the editor, Hattie Faye Bordeaux stated, “Frankie and I have taken corrective actions and made management changes to address the issues …”
Tarboro Town Councilman Taro Knight has worked for Cambridge for three years. He declined to comment this morning.
Florence Arnold Armstrong of Tarboro is the other Democrat in the primary. C.B. Daughtridge of Rocky Mount and Henry Williams of Tarboro are the two Republicans in the race.
Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities.
In 2006-07, Medicaid served approximately 1.7 million children, aged, blind and/or disabled individuals.
The budget for the 2007-08 Medicaid program was $11,345,677,668 – supported by $8,425,318,396 in revenue (predominately federal Medicaid funds) and $2,920,359,272 in state appropriations. Medicaid's budget is one of the largest in N.C. government – second only to the overall budget for primary and secondary education.
