The Office of the State Comptroller (OSC) recently issued an audit report finding that Heart to Heart, a home care provider with locations in Vineland, Paterson, Hackensack, East Orange, and Lakewood, 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.”