Seven adult care homes in North Carolina collected more than $8.4 million in Medicaid funding while employing untrained caregivers, some with serious criminal histories, Reveal from The Center for Investigative Reporting has found.

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Medicaid-funded caregivers in North Carolina are required to receive at least 80 hours of training within six months of being hired and can’t have criminal convictions for drug trafficking or other specific crimes.

But Reveal found many workers in the homes who said they received little to no training and identified several with criminal convictions that should have barred them from providing Medicaid-funded care.

The workers were participants in a drug rehab program called Recovery Connections Community. Rather than get treatment for their addictions, participants were required to work more than 16-hour days without pay, bathing, feeding and caring for elderly and disabled patients in care homes.

Jason Weinstock, a former Medicaid fraud prosecutor and investigator for the U.S. Health and Human Services Department’s inspector general, said this arrangement raises serious red flags. If he had received this information when he was a prosecutor, Weinstock said he would have opened an investigation.

“The criminal record thing is pretty concerning,” he said. “Any payments that are made for services by facility employees who have prohibited criminal histories or don’t have the required training are impermissible payments.”

Reveal could not determine whether the homes billed Medicaid for the rehab workers’ labor. If the homes knowingly skirted the rules by billing for the services of unqualified workers, they could face fraud charges. Even if they did not know, they could be forced to repay the government for any improper payments.

“No matter what, that money should go back,” Weinstock said.

The payments spanned a six-year period. Administrators from four of the care homes denied they billed Medicaid for unqualified workers. They told Reveal that all the rehab workers were properly trained and vetted.

“While I can certainly appreciate your desire to find Medicaid fraud or inadequate training, you’ll find neither here,” Chris Damiani, CEO of Integrity Senior Properties Investments, which owns three of the homes, wrote in an email.

Fred Leonard, owner of Cedarbrook Residential Center, said all rehab workers received the proper training.

“Cedarbrook has never worked any personal care aide past the six month timeframe without ensuring their participation in the 80 hour class,” he wrote in an email.

An administrator from the Marjorie McCune Memorial Center declined to comment on the home’s Medicaid billing practices. The other homes did not respond to requests for comment.

However, at least 15 participants who stayed in the program longer than six months told Reveal that they never received the required training. Participants who left the program prior to six months said they received little training or none at all.

“It is sickening,” said Robin West, a former rehab participant who worked at three different homes over five years in the program. “Why would you send somebody fresh off the streets, a drug addict, to go ahead into a home to take care of your mom or dad or anybody?”

Reveal reviewed the criminal histories of more than 70 Recovery Connections participants who worked in the care homes. More than half of the workers had criminal convictions, including for felony assault, identity theft and armed robbery. Four of the workers Reveal identified had criminal convictions for selling drugs that should have barred the homes from billing Medicaid for their services.

Hominy Valley Retirement Center in Candler, N.C., continues to employ rehab workers from Recovery Connections Community, according to several former employees and participants. Reveal found many such workers at adult care homes who said they received little to no training. Credit: Logan Cyrus for Reveal Credit: Logan Cyrus for Reveal

Tezra Bowers, a 50-year-old former patient at Integrity-owned Candler Living Center and Hominy Valley Retirement Center, remembers the rehab workers – and not fondly.

“They always had nasty attitudes,” said Bowers, who has a disability and said her care at the homes was funded by Medicaid. “They don’t treat people with decency.”

Bowers said several male rehab workers made lewd comments toward her and other patients. As Reveal has previously reported, at least seven rehab workers were accused of sexual misconduct or assault of patients at the homes.

In interviews with Reveal, staff and former participants recalled chaos and close calls involving rehab workers. At the McCune Center in Black Mountain, a rehab worker stood by dumbfounded as a patient choked during a meal; another raced a woman down a hall in her wheelchair, accidentally ramming her into a wall and gashing her leg. At Candler Living Center near Asheville, they said a Recovery Connections worker gave a patient the wrong medication, causing her to vomit repeatedly and gasp for air.

“Some of them didn’t know what they were doing,” said Chris Rice, a former supervisor at the McCune Center. “They were overwhelmed.”

Tezra Bowers’ son helps her into a chair outside her apartment in Asheville, N.C. Bowers says several male rehab workers made lewd comments toward her and other patients at Candler Living Center and Hominy Valley Retirement Center. Credit: Logan Cyrus for Reveal Credit: Logan Cyrus for Reveal

Reveal also found that rehab workers frequently would steal prescription medication from residents. Bowers said she and other patients frequently had their pain medications go missing. A former Recovery Connections worker was arrested last year and accused of stealing prescription medications at Candler, records show.

“It was awful,” Bowers said. “You was always in pain.”

In response to Reveal’s May report, the homes were barred from contracting with Recovery Connections until the program obtained the proper state licensure.

The McCune Center canceled its contract with the program. But Candler Living Center and Hominy Valley Retirement Center continue to employ the rehab workers, according to several former employees and participants.

The North Carolina Department of Justice is investigating whether the homes’ continued use of the workers violates the state’s cease-and-desist order.

Amy Julia Harris

Amy Julia Harris is a reporter for Reveal, covering vulnerable communities. She and Reveal reporter Shoshana Walter exposed how courts across the country are sending defendants to rehabs that are little more than lucrative work camps for private industry. Their work was a finalist for the 2018 Pulitzer Prize in national reporting and won a Sigma Delta Chi Award for investigative reporting from the Society of Professional Journalists. It also led to four government investigations, including two criminal probes and four federal class-action lawsuits alleging slavery and fraud.

Harris was a Livingston Award for Young Journalists finalist for her investigation into the lack of government oversight of religious-based day cares, which led to tragedies for children in Alabama and elsewhere. In a previous project for Reveal, she uncovered widespread squalor in a public housing complex in the San Francisco Bay Area and traced it back to mismanagement and fraud in the troubled public housing agency.

Before joining Reveal, Harris was an education reporter at The Charleston Gazette in West Virginia. She has also written for The Seattle Times, Half Moon Bay Review, and Campaigns and Elections Politics Magazine.

Shoshana Walter

Shoshana Walter is a reporter for Reveal, covering criminal justice. She and reporter Amy Julia Harris exposed how courts across the country are sending defendants to rehabs that are little more than lucrative work camps for private industry. Their work was a finalist for the 2018 Pulitzer Prize in national reporting. It also won the Knight Award for Public Service, a Sigma Delta Chi Award for investigative reporting, and an Edward R. Murrow Award, and was a finalist for the Selden Ring, IRE and Livingston Awards. It led to numerous government investigations, two criminal probes and five federal class-action lawsuits alleging slavery, labor violations and fraud.

Walter's investigation on America's armed security guard industry revealed how armed guard licenses have been handed out to people with histories of violence, even people barred by courts from owning guns. Walter and reporter Ryan Gabrielson won the 2015 Livingston Award for Young Journalists for national reporting based on the series, which prompted new laws and an overhaul of California’s regulatory system. For her 2016 investigation about the plight of "trimmigrants," marijuana workers in California's Emerald Triangle, Walter embedded herself in illegal mountain grows and farms. There, she encountered an epidemic of sex abuse and human trafficking in the industry – and a criminal justice system focused more on the illegal drugs. The story prompted legislation, a criminal investigation and grass-roots efforts by the community, including the founding of a worker hotline and safe house.

Walter began her career as a police reporter for The Ledger in Lakeland, Florida, and previously covered violent crime and the politics of policing in Oakland, California, for The Bay Citizen. Her narrative nonfiction as a local reporter garnered a national Sigma Delta Chi Award and a Gold Medal for Public Service from the Florida Society of News Editors. A graduate of Mount Holyoke College, she has been a Dart Center Ochberg fellow for journalism and trauma at the Columbia University Graduate School of Journalism and a John Jay/Harry Frank Guggenheim fellow in criminal justice journalism. She is based in Reveal's Emeryville, California, office.