Between 2008 and 2011, New Jersey submitted at least $32.2 million in unallowable Medicaid claims for personal care services, according to a new report from the Office of Inspector General (OIG).
Based on a previous audit that showed New Jersey submitted improper claims for personal care services between 2004 and 2007, the OIG audited a random sample of 100 claims between Aug. 1, 2008, and Dec. 31, 2011. Government auditors found that 17 of the reviewed claims did not meet federal and state requirements regarding nursing supervision, in-service training qualifications, physician certification or nursing assessments.
The OIG recommended that New Jersey refund the $32.2 million to the federal government and issue guidance to providers concerning personal care services. The New Jersey Department of Human Services argued that certain claims should be excluded because one provider's records were damaged by a flood. Additionally, the state took issue with the OIG's sampling methodology.
Improper claims for home care have been an ongoing concern for federal authorities. Last year, the OIG criticized the Centers for Medicare & Medicaid Services for failing to recoup overpayments linked to home health providers. Perhaps the largest home health takedown occurred in February 2014, when law enforcement officials arrested 25 people in the District of Columbia who were linked to home health fraud, including one excluded home health provider who bilked the government out of $75 million.
Other states have struggled to recoup home health overpayments for years. In particular, an investigation by The Star Tribune showed that Minnesota had convicted just 25 percent of the 425 home health agencies notified of wrongful billing practices since 2008.
- here's the OIG report
Home care fraud plagues government programs
The cautionary tale of Florence Bikundi, an excluded provider
Largest DC healthcare fraud takedown busts 25
Minnesota fails to recoup money from home health fraud