Adult Day Care Centers Billed for Ghost Care

NJ reaches multi-million dollar settlement with five centers

By GEOFF MULVIHILL
|  Wednesday, Mar 6, 2013  |  Updated 3:53 PM EDT
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Adult Day Care Centers Billed for Ghost Care

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A state agency that serves as a watchdog over New Jersey government announced Wednesday that it has found improper billing of Medicaid by five adult day care centers and is asking the centers to pay settlements totaling more than $10 million.

The state comptroller's office found that centers were charging the state for caring for patients when they did not receive care in some cases and for providing care that was not needed in others.

A lawyer for four of the facilities said the problems mostly concern record-keeping and that the centers are now providing more detailed documentation of care since they now know that's what the state wants.

State Comptroller Matthew Boxer said the investigation findings ``led us to have real concerns about the medical and clinical care they were providing.'' He said his office has given information about the centers to state prosecutors.

Boxer said his office launched the five investigations because of tips from other state agencies and, in one case, a former employee at the center.

He said there were serious problems at all five: 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; Golden Era Adult Medical Day Care in Edison; and Atlantic Adult Health Care in Northfield.

The facilities, like other adult medical day cares, provide services for people who have trouble doing daily functions, including taking medications they need. Across the state, there are 134 such centers, and they bill the state's Medicaid program about $200 million annually.

Boxer said investigators found recipients who did not appear to need the services. One patient needed a cane to walk, Boxer said, but had no reason to be enrolled.

In other cases, he said investigators found Medicaid received bills from day cares for patients who were on vacation and not attending the centers. Medicaid paid about $10,000 for the care of one patient who, it turned out never attended the center. And the report found one patient did not receive glucose monitoring for several months though the patient's doctor requested tests twice per week.

In other cases, medicine was authorized for patients who did not need it, the report found.

Robert Fogg, a lawyer who represents the four centers still in operation, said his clients are troubled by the timing of the report. ``My clients are not pleased,'' he said.

He said all of them were in negotiations to pay the state for infractions and some were on the verge of settling.

He also said that many of the problems cited were for record-keeping requirements that are not listed in state licensing documents. Now that the centers know the state wants to see that level of detail, he said, adult day cares across the state are keeping checklists of daily activities.

Boxer said the state will continue to monitor the centers that were the subject of the investigations.

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