A state comptroller’s audit found that New Jersey home care provider Heart to Heart improperly billed and was overpaid by Medicaid by nearly $2.4 million.
The provider billed New Jersey Medicaid for unsubstantiated services, failed to verify the professional qualifications of attendants, and failed to meet Medicaid quality of care requirements.
TRENTON – The State Comptroller’s Office (OSC) today announced it has issued an audit report that found Heart to Heart, a home care services provider with locations in Paterson, Hackensack, East Orange, Lakewood and Vineland, improperly billed Medicaid and received overpayments totaling $2,386,287, and must repay the overpayments to the program.
The OSC audit found that Heart to Heart did not perform in-home assessments on approximately 12 percent of claims sampled by OSC, even though Medicaid quality of care requirements require home care providers to have a registered nurse supervise home health care aide visits at least once every 60 days.
The audit also found that Heart to Heart did not verify the professional qualifications of its home health aides and allowed unlicensed individuals to perform services that were reimbursed by Medicaid.
Finally, the OSC identified allegations that Heart to Heart billed and received Medicaid payments for home care services during periods when beneficiaries were hospitalized in the hospital, in violation of Medicaid regulations that prohibit payment for home care services when a beneficiary is hospitalized.
“Home health care services are a necessity for many New Jersey residents enrolled in the Medicaid program,” said Josh Lichtblau, director of OSC’s Medicaid Fraud Unit. “The audit found that Heart to Heart did not comply with Medicaid regulations, including quality of care requirements designed to ensure Medicaid recipients receive appropriate home health care.”
“Medicaid providers who do not comply with these requirements adversely impact Medicaid beneficiaries and receive Medicaid payments they are not entitled to receive. Therefore, through this audit, OSC will outline corrective actions that Heart to Heart will take and will seek full repayment of underpaid Medicaid claims.”
In addition to seeking reimbursement for Medicaid overpayments, the OSC report specifically recommended that Heart to Heart review the licenses and certifications of its visiting caregivers, ensure compliance with all state and federal regulations, and provide proper compliance training for staff.
The Office of the State Comptroller (OSC) is an independent state agency that works to make New Jersey’s government more efficient, transparent and accountable. OSC examines all aspects of government spending, conducts audits and investigations of government agencies throughout New Jersey, reviews government contracts, and works to detect and prevent fraud, waste and abuse in Medicaid.
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