As Medicaid coverage increases in N.J., concern about fraud grows, too

A Medicaid fraud guilty plea announced this week by the state attorney general’s office highlights an emerging issue: As Medicaid coverage in New Jersey is expanded under the Affordable Care Act, vigilance is needed to avoid an increase in fraud.A former employee of a New Jersey home health agency pleaded guilty Monday to charges that he caused bills to be submitted to the Medicaid program for services that were never provided, according to acting Attorney General John J. Hoffman and the state Office of the Insurance Fraud Prosecutor.

In a statement, Hoffman said Naum Lavnevich, 57, of Oakland, pleaded guilty to one count of second-degree health care claims fraud before Bergen County Superior Court Judge Edward A. Jerejian. As part of the plea agreement, the state recommended that he serve three years in state prison and pay restitution in the amount of $5,614. His sentencing is scheduled for April 10.

According to attorney general’s office, Lavnevich admitted that between January 2008 and October 2010, he caused 178 claims to be submitted to Medicaid for services that were not provided.

Lavnevich was employed by Confident Care Corp., which did not respond to a request to comment on the case.

According to the attorney general’s office, Lavnevich is one of six current or former employees of Confident Care to be charged by the OIFP for fraudulent Medicaid billing.

Acting Insurance Fraud Prosecutor Ronald Chillemi said there have been major fraud cases that started with anonymous tips. He encouraged anyone with information about a possible fraud to report it anonymously by calling the toll‑free hotline at (877) 55‑FRAUD, or visiting the website NJInsurancefraud.org. Chillemi said state regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.

In its latest annual report, the OIFP reported that, in 2012 and 2013 combined, the False Claims Act group in its Medicaid Fraud Control Unit recouped about $72 million for the state’s Medicaid program: “by far the highest two-year total for this program since it was formed in 2008.” The report said the results point to the OIFP’s ability “to successfully handle large cases against more sophisticated adversaries.”

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, said, “When providers charge for things that aren’t really being done or shouldn’t be done or overcharge, they not only cheat the taxpayers, but they are depriving honest patients and providers of resources that are desperately needed.”

Schwimmer added: “This is especially true as the number of beneficiaries in Medicaid expands, and we try to keep people in their homes as long as possible. High quality home care is essential and fraud diminishes the ability to support it. Patients and their caregivers should make sure that they do not sign documents stating that they received care that they did not really receive.”

Schwimmer urged individuals who have any fraud concerns to contact the New Jersey attorney general’s office.

Chrissy Buteas, chief executive and president of the Home Care Association of N.J., said her organization applauds the work of the Office of the Insurance Fraud Prosecutor. She said Confident Care is not an association member.

“Our association lobbied for and won passage of a state law that will require all health care service firms to not only receive accreditation, but to undergo an annual financial audit,” Buteas said. “We will not allow unscrupulous agencies to profit from families who are only looking to ensure proper care for a loved one and will continue to work with the administration to protect the public by ridding the industry of bad actors.”

She said her members “are committed care providers who put the needs of the patients in their care above all else and ascribe to the highest level of professionalism and ethics. The families across the state who rely on our member agencies and home health aides for care should rest assured that we have safeguards in place to protect against fraud.”

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