New Jersey Medical Group Faces Scrutiny Over Unusual Medicaid Billing

An investigation has uncovered extensive irregularities in Medicaid billing by a New Jersey-based medical group. The group, identified as Honor Health Network, has been involved in billing nearly $950 million for home health care and adult day care services. Federal spending data revealed that Broadway Respite and Home Care, situated in Fair Lawn, had claimed a staggering $157 million from Medicaid by serving 89,000 unique patients over six years. This number appears inflated, given that there are only about 20,000 elderly Medicaid recipients in the entire county, according to Georgetown University data.

In a similar vein, Broadway Adult Day Care billed Medicaid $40 million between 2018 and 2024 for around 28,000 patients. A former Medicaid fraud investigator, preferring to remain anonymous, described these numbers as unusual and problematic.

The home care sector receives significant funds annually from Medicaid, intended to provide care for elderly and chronically ill individuals. However, fraudulent activities frequently plague this sector, as highlighted by prior investigations and federal authorities. From 2018 to 2024, other operations under Honor Health Network, specifically in Brooklyn, racked up a total of $396 million in Medicaid billing.

Various accounts from clients of these services suggest inadequate and dubious care quality. An 80-year-old former client, Serena Abekassis, stated that her caregivers were incompetent, leading to severe neglect. Her children corroborated her complaints, citing instances where caregivers failed to perform essential duties and allegedly stole personal belongings.

Quality Healthcare, operating within the same network, has yet to address these allegations. Meanwhile, it has been noted that the usage of billing codes by these entities was quite limited—using predominantly one code per service that suggests potential fraudulent practices. This billing pattern has raised suspicions among authorities.

Broadway Respite & Home Care, alongside Broadway Adult Day Care, continues to bill significant amounts under codes typically covering essential domestic help, such as assisting with bathing, dressing, and day care activities. However, the industry typically employs various codes for different services like transport, memory care, and more.

Despite significant Medicaid cash flow throughout the network, Honor Health Network and its affiliates have not been formally accused of legal wrongdoing. They have not responded to requests for comment on accumulated allegations and suspicious billing activities.

Analyzing the data, a former fraud investigator found the reported patient volumes for these facilities surprising. He explained that similar investigations have showcased patterns of ‘double dipping,’ where a single individual is fraudulently registered multiple times under different identities.

Fair Lawn, located in affluent Bergen County, shows stark economic contrasts compared to Medicaid-dense areas like Flushing, Queens. In Fair Lawn, the median household income stands at $144,000, making Medicaid eligibility questionable for many residents. Medicaid rules stipulate that benefits should only extend to seniors with minimal assets.

Honor Health Network, launched in 2013, operates across eight states and DC, claiming to serve over 15,000 patients through numerous agencies. Within New Jersey, several agencies have been noted for questionable billing practices over a six-year period, drawing Medicaid payouts reaching over $950 million.

Other entities in the network, like First Horizons Home Health Care in Indianapolis, experienced unusually high billing compared to regional averages. Families have expressed concerns over the transparency of billing hours and expressed frustration over the quality of care. There is a consensus on the lack of oversight and control over the services billed to Medicaid.

Recent visits to Broadway Adult Day Care revealed an environment bustling with apparently healthy seniors. Administrator Yuri Mitchell provided insights into the operations while clarifying that financial procedures are handled by a different department. However, he declined to disclose further details concerning the reported high numbers of unique patients.

As part of an extensive Medicaid fraud crackdown, federal agents have recently raided adult daycare centers across Brooklyn, Queens, and Staten Island. The operation targeted over 100 providers involved in alleged money laundering, kickbacks, and unethical billing.

The industry’s financial motivations seem to have overshadowed its service-oriented mission, according to former Broadway Respite owner Errol Seltzer. The investigations echo The Post’s findings, highlighting systemic fraud in areas like Flushing, Queens, where adult day cares excessively bill Medicaid, aligning with the issues faced in New Jersey.