N.J. owes $32M for improperly billing Medicaid for home health care, report says

TRENTON — The state improperly billed $32.2 million for home health services it could not document over a 3-1/2-year-period and should return the money to the federal government, according to a U.S. Office of Inspector General report released Monday.

A random audit of 100 claims submitted from 2008 to 2011 found 17 to be in error because they did not contain proper documentation, according to the report. The deficiencies included nurses not making required visits, companies using untrained home health aides, and failing to maintain patient files.

Based on this "error rate," investigators estimated the state Department of Human Services would have improperly overbilled for $32.2 million, or about 8 percent of the $393 million the U.S. Department of Health and Human Services paid New Jersey to provide home care to elderly and disabled homebound residents, according to the audit Inspector General for the U.S. Department of Health and Human Services.

The state's track record is spotty, according to the report by Regional Inspector General James P. Edert.

"During a prior review of New Jersey's personal care services program, 2004 through 2007, we identified a significant number of services improperly submitted for federal Medicaid reimbursement. On the basis of these results, we decided that another review of this program is warranted."

Valerie Harr, director of the state Division of Medical Assistance and Health Services, challenged five of the 17 claims for "extraordinary circumstances" that included two home health agencies going out of business, one agency losing files in a flood, and some files being older than five years – the length of time state law requires these documents to be kept. In other instances, Harr's office was waiting more documents from home health care agencies to respond to other questions, according to Harr's written response to the audit.

Harr also questioned whether the claims were truly representative of the 18.2 million others submitted during this study period.

Federal investigators agreed to dismiss one complaint involving the files destroyed in a flood. "We maintain that our remaining findings and recommendations are valid," according to the investigators' response.

The audit was first reported by The Record.

The state was just cited in June by the Inspector General for lax monitoring of its home health workers.

An audit of 150 randomly selected claims from 2007-08 turned up 38 in which home health aides lacked the proper training or supervision, hadn't had their own health screened for communicable diseases, or hadn't had the proper check of their background and certification.

If that same failure rate occurred in all the claims during the 19-month period, 73,260 claims would have had some kind of error. Taxpayers paid more than $4 million for those problematic claims.

Susan K. Livio may be reached at [email protected]. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.

Original Article