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Home Health Aid Agency In Union County Charged With Billing Government Medical Programs For Services Not Provided

TRENTON – Acting Attorney General John J. Hoffman announced that the owner of a Union County home health aid agency has been charged in a 30-count indictment for allegedly billing Medicaid and the United States Department of Veterans Affairs more than $100,000 for services never rendered. 

Laurie Provost, 54, of Sea Girt, was indicted yesterday (May 14) on 23 counts of second-degree health care claims fraud, and one count each of second- and third-degree theft by deception, third-degree Medicaid fraud, third-degree health care claims fraud, fourth-degree forgery, and two counts of fourth-degree falsifying or tampering with records.

“Through her greed, this defendant allegedly defrauded the Medicaid Program, a program that helps New Jersey’s most vulnerable population and the United States Department of Veterans Affairs, a department aimed at helping those who gave so much for their country,” Acting Attorney General Hoffman said. 

“The Medicaid program is in place for people who truly need assistance paying their medical bills,” Acting Insurance Fraud Prosecutor Ronald Chillemi.  “It is not there as a piggy bank for unscrupulous health care professionals.  The Office of the Insurance Fraud Prosecutor will continue to be vigilant in prosecuting these high priority cases.”

Provost was the owner/operator of Home Care Solutions, located on Commerce Drive in Cranford.   Home Care Solutions (HCS) was a home health aid agency that sent home health aides to the homes of Medicaid beneficiaries to provide them with care.  The agency also contracted with skilled medical professionals to provide specialized services to patients who required such care. The agency was closed as a result of the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit’s investigation.

The state grand jury indictment alleges that between July 23, 2011 and Aug. 7, 2013, Provost, through HCS, submitted hundreds of fraudulent claims to Medicaid and/or one of the managed care organizations that provide services to Medicaid beneficiaries and processes provider claims and payments on behalf of the Medicaid program. It is alleged that Provost knowingly submitted requests for payment for services that were not provided, including billing for services purportedly provided to Medicaid beneficiaries by home health aides while the beneficiaries were hospitalized or on vacation.  An investigation by the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit determined that, through the fraud, Provost allegedly defrauded Medicaid of more than $100,000.

The investigation determined that between May 12, 2011 and April 9, 2013, Provost allegedly stole over $44,000 from the United States Department of Veteran Affairs by creating the false impression that services were provided to veterans, and therefore HCS was entitled to payment. 

The indictment also alleges that between March 6, 2010 and July 11, 2013, Provost committed Medicaid fraud by allegedly making false statements on her agency’s Medicaid provider application.  When she submitted HCS's application to become a Medicaid provider, Provost allegedly hid the fact that her nursing license was suspended.  An investigation determined that the Medicaid program would have rejected her application if she disclosed the fact that her nursing license was previously suspended. It is alleged that, as a result of her application fraud, the Medicaid program paid Provost through HCS more than $2 million.

The indictment further alleges that between March 24, 2010 and July 11, 2013, Provost created forged in-service training records, giving the false appearance that HCS met regulation and accreditation standards.

 

Lastly, between July 21 and Dec. 31, 2009, Provost allegedly submitted documents containing fraudulent statements to the New Jersey Commission on Accreditation regarding HCS’s Director of Nursing.  On May 12, 2011, Provost allegedly provided similar fraudulent information to the Department of Veterans Affairs. 

Deputy Attorney General Christopher Ruzich and Detective Anthony Iannice of the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit coordinated the investigation.  Auditor Cleair Budhu assisted in the investigation.  Acting Insurance Fraud Prosecutor Chillemi thanked the New Jersey Office of the State Comptroller for referring the matter to the Office of the Insurance Fraud Prosecutor.  Acting Insurance Fraud Prosecutor Chillemi also thanked the Department of Veterans Affairs for its assistance in the investigation.

The indictment is merely an accusation and the defendant is presumed innocent until proven guilty. Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of up to $150,000, while third-degree crimes carry a maximum sentence of five years in state prison and fine of up to $15,000.  Fourth-degree crimes carry a maximum sentence of 18 months in jail and a criminal fine of up to $10,000.

joan peters May 18, 2014 at 05:14 PM
And they couldn't check the applicant's credentials online? Yeesh.

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