The owner of a drug treatment and mental health counseling firm must return $1.1 million to the state’s Medicaid program for hiring unlicensed counselors and failing to conduct background checks on employees working with children. report Thursday New Jersey State Audit Office.
An audit found that John Gore himself was a licensed drug and alcohol counselor, was also billed for unsubstantiated services, kept sloppy records, and had a contract employee with a valid driver’s license. It turned out that we were unable to confirm this.
However, the state’s Department of Social Services, which runs a Medicaid program that serves more than two million low-income individuals, has taken some action against companies’ behavior by not verifying that their counselors meet licensing requirements. are responsible for, the report said.
The Secretary recommended that the Murphy administration either seek legislation or adopt regulations requiring these contractors to be fingerprinted, the gold standard for security measures. The state will also “must provide detailed requirements on when and how employees will receive education and driver license verification,” but it’s a vague process at this point.
“For teachers, doctors, coaches, and many others who work with children, getting fingerprints checked is standard practice. Children participating in these Medicaid-funded community programs You are entitled to the same protections,” said Josh Lichtblau, director of the Auditor’s Medicaid Fraud Division.
“Our findings are serious,” added Lichtblau. “If providers cannot ensure that their employees have clean criminal records, they are putting vulnerable children in potentially dangerous situations. need to work on.”
John Gore founded Clear Conscience Counseling in South Plainfield eight years ago, according to its webpage. certification committee, An educational and accrediting agency for drug treatment professionals in New Jersey. Gore did not respond to emails and phone calls seeking comment on the report on Thursday.
“We will continue to work to address this issue,” a Department of Health and Human Services spokesman said, noting that the department instructed state-contracted providers to introduce fingerprint-based background checks in September.
“Children’s safety is a top priority and authorities have supported every step of the way to extend background check fingerprinting to these providers,” said spokesperson Tom Hester. “The Department has zero tolerance for provider fraud or misuse of Medicaid funds and will always work together to support the Medicaid Fraud Division’s mission to detect and recover misused taxpayer funds. increase.”
Gore and his employees provide “intensive community mental health rehabilitation” and “behavioral support services” for children and young people. It is usually done at home, but always in an outpatient setting.
According to the report, the General Accounting Office based its conclusions on a review of 818 medical claims worth a total of $157,536 filed with Medicaid by Gore and 116 “behavioral assistants” between 2016 and 2020. bottom. Investigators found 34% of his claims to be flawed, the report says.
Of the $157,536 that Gore charged Medicaid, $39,567 was found void because Gore did not follow the rules. Based on this error rate, the auditor determined that Gore owed $1,160,371 to his office on Medicaid, based on his $5.24 million paid during these four years. Did.
State regulations require behavioral assistants to hold a driver’s license and high school diploma and be at least 21 years of age. Additionally, you must complete training and obtain a Behavioral Support Training certification within six months of being hired to recertify each year.
Gore assigned cases to at least six behavioral assistants who didn’t have the necessary professional licenses to do the job, and hired 24 behavioral assistants who didn’t have the necessary training qualifications. It was also found that he did not arrange a background check for the 19 behavioral assistants before working with the children.
According to the report, the inspector general’s team also found 10 suspicious allegations that indicated the child was being treated by two behavioral assistants simultaneously or overlappingly.
In a written response to a report last fall, the law firm representing Gore said it hired third parties to handle personnel matters such as education and verification of professional qualifications, adding: We don’t maintain backups.”
“Additionally, several documents were stolen during a robbery at the company in December 2020,” said an unsigned letter from Gore’s legal representative in the Oberheiden office.
“We are grateful to the OFC for the time and effort put into analyzing the company and understanding that our clients need better performance when it comes to delivering Medicaid services. Reliance on outsourced HR vendors and robbery are two reasons behind this failure, according to a letter filed in October.
Lichtblau and Deputy State Comptroller Kevin Walsh have requested the Department of Human Services for Medical Assistance and Health Services. November 2021 And also earlier this month to draft stricter rules or call for legislation to ensure contract vendors like Gore’s company meet screening requirements.
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Susan K. Livio can reach [email protected]Follow her on Twitter @SusanKLivio.
