A Northfield facility has been named in a list of five recently investigated for Medicaid fraud in the state.
Atlantic Adult Day Health Care was among those facilities cited by the Office of the State Comptroller for improper Medicaid billing. The comptroller is seeking more than $10 million in repayment from the facilities, including $1.8 million from the Northfield center.
Adult day care centers are used to provide medical services and assistance for adults who don’t need 24-hour inpatient care, but are impaired, according to the Comptroller’s Office. The average reimbursement from state Medicaid per year to these facilities is about $195 million.
The Comptroller’s Office, which serves as a watchdog over New Jersey government, said Wednesday it had found facilities were receiving state payments on behalf of individuals who did not attend the facilities on dates claimed and individuals who had never been in the programs. The office also found that facilities received public funding for individuals even though they did not need services. In some cases, they were not eligible for it.
Without documentation, such as a sign-in log indicating a stay of more than five hours, the facility is not eligible for payment for that individual, according to the state.
Atlantic Adult Day Health Care received more than $16.2 million in reimbursements from 2002 to 2011. The Comptroller’s Office reviewed 228 claims submitted between June 1, 2010, and May 31, 2011. Of those reviewed, 133 signatures were not recorded, and no arrival or departure times were recorded for any of the 228 days.
“It is apparent, however, that more aggressive monitoring of (adult medical day care) facilities is needed,” Comptroller Matthew Boxer said. “This series of OSC investigations has revealed repeated and substantial waste of taxpayer dollars.”
Tips from other state agencies and, in one case, a former employee at a center, helped Boxer launch his five investigations.
The comptroller found significant problems at all five facilities, which also include Oceanview Adult Medical Day Care in Lakewood, which is now closed; Home Sweet Home Adult Medical Day Care in Elizabeth; Belleville Adult Medical Day Care in Belleville; and Golden Era Adult Medical Day Care in Edison.
Among the alleged violations: Medicaid received bills from day care centers for patients who were on vacation and not attending the centers. Medicaid paid about $10,000 for the care of one patient who never attended the center. One patient did not receive glucose monitoring for several months, although the patient's doctor requested tests twice per week.
The report also found medicine was authorized for patients who did not need it.
The Comptroller’s Office is negotiating for a repayment of $1.8 million from Atlantic, which includes penalties, said spokesman Peter McAleer. The total is an estimate of the loss to the state during the year in fraudulent claims.
An appeal was filed by Atlantic in December.
The state’s findings are “not indicative of any wrongdoing on the parts of these providers,” said Robert Fogg, the attorney representing Atlantic, in the Princeton office of Archer and Greiner law firm.
Many of the problems cited were for record-keeping requirements not listed in state licensing documents. Fogg said adult day care centers across the state now are keeping checklists of daily activities.
“There are a lot of inaccuracies in these reports that are used to embellish the state’s position. But we hope to resolve this amicably,” Fogg said.
The Associated Press contributed to this report.
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