NJ home care provider required to repay $2 million in overpayments from Medicaid
Kaitlyn KanzlerA statewide home care provider was found to have received over $2 million in Medicaid overpayments by improper billing and will have to repay the money to the program, according to the Office of the State Comptroller.
Heart to Heart, which has locations in Paterson, Hackensack, East Orange, Lakewood and Vineland, not only received $2,386,287 in overpayments, the comptroller stated that the company allowed an uncertified home health aide to perform billable services and failed to perform in-home evaluations in at least 12% of the claims sampled by the comptroller.
Medicaid requires that home care providers have a registered nurse supervising home health aid visits at a minimum of once every 60 days.
A number of claims were found where Heart to Heart billed Medicaid for at-home services and received payments while those utilizing their services were in the hospital, the comptroller said. This violates a regulation that prevents payment for services while someone is in an "inpatient setting."
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"Our audit found that Heart to Heart failed to comply with Medicaid regulations, including quality of care requirements designed to ensure that Medicaid beneficiaries receive appropriate home-based care," said Josh Lichtblau, Director of OSC’s Medicaid Fraud Division.
Not only will Heart to Heart have to reimburse Medicaid for the overpayments, but the report by the comptroller also recommends that licensures and certifications of its home health aides be verified and for "appropriate compliance training" be implemented for its staff.
Kaitlyn Kanzler covers Essex County for NorthJersey.com. For unlimited access to the most important news from your local community, please subscribe or activate your digital account today.
Email: kanzler@northjersey.com
Twitter: @KaitlynKanzler8