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We All Make Mistakes

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

What do the old and the young have in common? A shared vulnerability and dependence on people. However, seniors don’t quite have the same care options that kids do. And honestly, the kids’ options are that great! Seniors face multiple barriers to care including high cost, lack of access to medicines and transportation to clinics, enough trained providers to care for them, and age discrimination. Makes it all the more important to make sure that Medicaid funds are allocated correctly. Or not stolen. Unfortunately, that isn’t always the case. On October 30, 2023, the New Jersey Office of the State Comptroller released a report from their audit. After evaluating claims data from 2016 to 2022, they found almost two dozen adult day care centers that had overbilled the Medicaid program for services that never happened.

Twenty-one adult day care centers that provide medical care and social activities for homebound seniors, disabled adults, those with dementia and others have netted almost $1 million from Medicaid without providing one single service. The most common infraction: billing for more than five days a week. 7,849 claims, totaling $613,286, were billed for more than a five-day work week. Meaning no one was in the office. The building was closed. Yet services were billed for those days.

Whether the improper billing was due to careless mistakes or intentional fraud, these AMDCs were paid for services that were unauthorized and in many cases, not delivered.  It doesn’t appear to be that criminal charges are filed. The comptroller has contacted the center operators who have erroneously billed and have given them an opportunity to challenge the findings or refund the money. After all, we all make mistakes. Right?

Today’s Fraud of The Day is based on article “Adult day care centers billed N.J. $1M even though their buildings were closed, report says” published by New Jersey Advance Media on October 31, 2023

Adult medical day care centers keep elderly and disabled people out of nursing homes by serving them meals, helping them bathe and administering their medications. But in New Jersey, an investigation found 21 centers also helped themselves to extra payments by overbilling for time never spent with their clients.

The Office of the State Comptroller released a report Tuesday that said these center operators overbilled the Medicaid program, supported by tax dollars from the federal and state governments, nearly $1 million.

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