Medicaid Fraud for Short-staffing

The Office of State Comptroller Medicaid Fraud division settled with three New Jersey nursing homes to pay Medicaid $2.1 million after reviews revealed serious understaffing in violation of legal requirements.

The OSC’s Medicaid Fraud Division found that all three New Jersey nursing homes, Barnegat Rehabilitation and Nursing Center, Belle Care Nursing and Rehabilitation Center, and Barclay’s Rehabilitation and Healthcare Center, all failed to meet the minimum staffing requirements set every day of the month.

The Division reviewed copies of professional licenses, timesheets, and payroll records of July 2023. OSC is seeking to recover the funds that Medicaid paid to each facility during July 2023.

Due to the pervasiveness and seriousness of these deficiencies, OSC is imposing penalties “proportionate to the severity of understaffing.” Additionally, OSC will withhold ten percent of future Medicaid payments until the funds are paid back to New Jersey Medicaid.

These facilities have the legal right to challenge OSC’s findings if they choose. However, the facility’s own data from 93 shifts (day, evening, and night) for the 31 days of July revealed that all three facilities failed to meet the required staffing levels.

Barclay’s Rehabilitation and Healthcare failed to adequately staff 85 of the 93 shifts, and OSC found that one aide continued to work for seven days after their certification experience. Barnegat Nursing and Rehabilitation Center did not adequately staff 86 of the 93 shifts, and Belle Care Facility did not staff 83 of the 93 shifts.

The most alarming data revealed that Belle Care did not have any direct care staff members present to care for 82 residents in 3 of the 93 shifts. Damages appear as follows: $735,180 from Barclays, $791,380 from Barnegat, and $647,304 from Belle Care.

In late March, OSC sent initial notices to each of the three facilities, notifying them of their findings. The facilities did not argue against OSC’s findings and failed to submit corrective action plans. Instead, they said that the staffing mandates are too “onerous” and “unconstitutional.”

“The minimum staffing requirements are clear, and they were put in place because residents rely on nursing home staff for their daily needs,” said Josh Lichtblau, Director of OSC’s Medicaid Fraud Division. “And the numbers don’t lie. We looked at 31 days, and they failed to meet the legal requirements every day. Nursing home residents deserve adequate staffing, and the Medicaid program should demand nothing less.”