00:001.8,000 beneficiaries. Does that seem right to you?
00:04One New Jersey-based Medicaid conglomerate has billed tax fares over $950 million in what appears
00:10to be shady billing records, according to an investigation from the New York Post.
00:14This company called Honor Health Network, based in Bergen County, New Jersey,
00:18owns Medicaid providers all across the country, primarily in the home healthcare sector and the
00:24adult daycare sector. One thing about these daycares that we can't really seem to figure
00:28out is what exactly are they supposed to be for? Now, according to Medicaid, adult social adult
00:32daycares are supposed to be for chronically ill, homebound adults who have severe disabilities,
00:38mobility issues, basically people who should be in nursing homes, but they're not. The idea behind
00:44it is actually one that most people agree with. It's the idea that if you have a severe, chronically
00:49ill, infirm, older person in your family, in order to keep them out of a nursing home, you would hire
00:55someone to take care of them in their own home, usually a family member. Taxpayers pay for this.
01:00Then for a social outlet, you have the adult daycare aspect. So for elderly, chronically ill
01:06seniors who are unable to leave the home would then go to a daycare for a little bit of social
01:11interaction. This is how the system is meant to work. But what has been proven in the last 10 years
01:16is that it is rife with fraud. HHS fraud investigators told us that one thing they look for
01:21when they're examining Medicaid records is companies that bill for a very high amount
01:26of money, coupled with a low amount of billing codes, usually just one or two billing codes.
01:32A billing code is basically what a Medicaid provider is charging taxpayers for, whether it
01:37be transportation services, cleaning someone's home, administering medication, helping someone
01:42get to bed. We visited two of these companies in New Jersey, Broadway Respite Home Care, which
01:48billed taxpayers $157 million using just one billing code, and across the street, Broadway
01:54Adult Daycare, which had billed taxpayers some $40 million using a single billing code.
02:00These two companies are owned by a healthcare conglomerate called Honor Health Network, based
02:04in Bergen County, New Jersey. Among the Medicaid businesses owned by this conglomerate, we identified
02:08nearly a dozen that seem to have shady billing practices. Some of them, based in Brooklyn, were
02:14billing upwards of $400 million over the six-year period for one or two billing codes.
02:21We stepped into Broadway Respite Home Care Services, where we were told by a woman who identified
02:26herself as the manager that she didn't know how many patients they currently were serving.
02:31According to the data, it says that you have 89,000 beneficiaries that you have worked with.
02:35Does that sound right to you?
02:37You don't know?
02:37No, I'm sorry.
02:38She didn't have any comment about the billing numbers that we presented to her, and she basically
02:44told us to reach out to a man in the corporate office at Honor Health Network. That individual
02:50did not respond to multiple requests for comment. Everywhere we went, we encountered managers
02:55who seemed to have no information about the billing practices. At Broadway Adult Social Daycare,
03:02Yuri, the manager, told us that he didn't know anything about the numbers we were showing him.
03:06He didn't know anything about billing and insisted that was all handled by corporate.
03:10We are part of, like I said, like a corporation. All this spending things go through our financial
03:15department, which is not even in this building.
03:18He told us that he didn't know about the nearly 30,000 patients, individual patients who were
03:23listed on HHS data as having attended there over the six-year period. Now, to put it into context,
03:30our research shows that there's only about 20,000 Medicaid-eligible seniors in all of Bergen County.
03:36Last summer, the Post did a deep dive on what's called New York's Medicaid fraud capital,
03:40Flushing, Queens, where there are over 80 social adult daycares within a one-mile radius,
03:45billing taxpayers some $100 million a year. Last month, federal investigators announced a string
03:51of arrests and charges for daycare providers in Brooklyn and Queens, in which they alleged that
03:57those providers were providing kickbacks to patients. This is a system in which daycares compete
04:02for patients to come, and they offer them money in return for their Medicaid number.
04:06They then billed Medicaid for services that that patient is supposedly getting,
04:10and they give the patient a cut. Now, none of these businesses we investigated in New Jersey
04:14have been accused of any wrongdoing, but we've noticed a similar pattern of billing cycles that
04:19were rampant across New York State and New Jersey. Now, a lot of these businesses that we saw
04:24were billing something like 5, 10, even 700 times higher than the median amount that they were
04:31billing for in the area. The Broadway Respite Home Care Service is 68 times higher than any other
04:37home care service in that area. Honor Healthcare Network did not respond to multiple requests for
04:42comment, and they have not been accused of doing any wrongdoing.
