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Hugh Eighmie II, a lawyer with Gary's firm who is working on the Dominion case, said company workers told clients they were signing up for mentoring so they wouldn't be scared away from mental-health treatment.

Mental illness carries a heavy stigma, especially in minority communities, Eighmie said, and it's important to talk to clients in terms they can understand.

"They do understand terms like 'mentoring,' " he said.

Others questioned, too

Dominion is not the only company with bills attracting attention.

Workers at American Health & Human Services, a community support agency in Elizabeth City, billed Medicaid for picking children up for school, watching them take tests and eat lunch, and watching them play after school, according to company records.

One community support worker spent eight hours with an elementary school student. His goal for the day was to "increase frequency of on task behavior and following directions."

This is the worker's report of what happened from 10:01 a.m. to noon on Jan. 3, 2007:

"1. Client entered gym class quietly. Mentor extended verbal praise to client for his behavior. Client responded by saying thank you.

2. Client participated in the class activities. Mentor complimented client for his class participation. Client responded by saying thank you.

3. Client listened to the gym teacher instructions. Mentor complimented client for being attentive. Client responded by saying thank you.

4. Client lined up quietly to go to lunch. Mentor complimented client for following teachers' directions. Client responded by saying thank you."

The worker made similar notes for the rest of the school day and for two hours after, logging an eight-hour day and allowing American Health & Human Services to charge $488.

Reviewers from the regional mental-health office criticized the services for not building skills or working toward clients' goals.

The state wants the agency to repay about $500,000. American Health & Human Services owner Andrea L. Simpson has repaid some money but said he would appeal the most recent repayment order for $211,957.

Simpson said the company stopped sending workers into schools, though he thinks workers still need to be there.

"You have to teach a child a skill," he said. "If you cannot get their behavior under control first, then you can't teach them a skill."

He blames the state for the confusion about what companies are allowed to do; early on, the state did not require training in community support. Then, when his workers went to training sessions, he said, instructors would not give answers about what's right or wrong.

Wayne Peel of Williamston, who runs an independent company that trains community support workers, said the early lessons the state required did little to help providers new to the mental-health field.

"The training in the beginning was inadequate," Peel said. "I don't think you would find anyone that disagreed with that."

State officials underestimated how many people with little knowledge or training in mental health would start offering community support, he said. "Didn't have any," Peel said of some of the providers' experience. "Nada. Zero."

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