Comptroller alleges Medicaid fraud at 3 facilities

TRENTON – The state is seeking to prevent three health care operations from participating in the Medicaid program, alleging thousands of improper reimbursement claims were submitted over a three-year period.

The state Comptroller today filed a $2.7 million claim against facilities in Lawrence and Neptune, alleging they sought to obtain compensation for which they were not entitled.

The office said that at one facility, fraudulent entries were made on medical records during the Comptroller’s investigation to create the false appearance that services had been provided.

 “The integrity of the Medicaid program is dependent on health care providers acting in an ethical manner,” State Comptroller Matthew Boxer said in a release announcing the action.

“In this case, the  overbillings that we allege occurred, along with the effort to cover up those overbillings, were particularly brazen.”

The Comptroller seeks to have three operations debarred from participating in the Medicaid program for five years:

* Howard Lundy – the owner of Guiding Light Behavioral Health Inc., Neptune;

* Brighter Day Behavioral Health Inc., Lawrenceville;

* Guiding Light Drug and Alcohol Treatment Service, Neptune.

In addition, the license to provide health care services to Medicaid beneficiaries would be terminated for all three of those facilities, the Comptroller reported.

The state alleges that the three companies submitted more than 2,800 false Medicaid claims between September 2009 and March 2012.

The Comptroller reported that the facilities sought reimbursement from Medicaid for hundreds of patients who were not in attendance on the days billed, as well as for services that actually were provided by a different vendor.

One facility billed Medicaid for health care and transportation services on two separate days on which the facility was closed, according to the Comptroller.

Notice: 

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Comptroller alleges Medicaid fraud at 3 facilities