State Comptroller audit finds that Heart to Heart, a New Jersey home care provider, improperly billed and was overpaid nearly $2.4 million by Medicaid

Provider billed New Jersey Medicaid for unsubstantiated services, failed to verify an aide’s professional certification, and did not satisfy a Medicaid quality of care requirement.

TRENTON – The Office of the State Comptroller (OSC) today issued an audit report finding that Heart to Heart, a home care provider with locations in Paterson, Hackensack, East Orange, Lakewood and Vineland, improperly billed and received Medicaid overpayments totaling $2,386,287 that it must repay to the program.

OSC’s audit found that Heart to Heart failed to perform an in-home evaluation in about 12 percent of claims OSC sampled, despite a Medicaid quality of care requirement that requires home care providers to have a registered nurse supervising home health aide visits at least once every 60 days.

The audit also found that Heart to Heart failed to verify the professional certification of a home health aide, and allowed the uncertified individual to perform services that were reimbursed by Medicaid.

Finally, OSC identified claims where Heart to Heart billed and received Medicaid payments for at-home services during periods that beneficiaries were inpatient in a hospital, which violates a Medicaid regulation that bars payment for at-home services when a beneficiary is in an inpatient setting.

“In-home health care services are a necessity for many New Jerseyans enrolled in the Medicaid program,” said Josh Lichtblau, Director of OSC’s Medicaid Fraud Division. “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.

“Medicaid providers who fail to adhere to these requirements adversely affect Medicaid beneficiaries and receive Medicaid payments they are not entitled to receive. Accordingly, through this audit, OSC outlines corrective actions that Heart to Heart needs to take and we seek full repayment for its deficient Medicaid claims.”  

In addition to seeking reimbursement of the Medicaid overpayment, OSC’s report specifically recommends that Heart to Heart verify licensures and certifications of its home health aides, ensure that it is adhering to all state and federal regulations, and institute appropriate compliance training for its staff.  

The Office of the State Comptroller (OSC) is an independent State agency that works to make government in New Jersey more efficient, transparent and accountable. OSC is tasked with examining all aspects of government expenditures, 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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