Owner of Totowa Nursing Home Sentenced for Billing Medicaid Program for More than $100,000 in Personal Expenses.
Fraud investigated by Attorney General's Office and Department of Health & Senior Services.
TRENTON - Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor announced that the owner of a Totowa nursing home was sentenced today for fraudulently obtaining payment from the Medicaid Program. A state investigation revealed that he billed the Medicaid program for $302,877 in improper and unsubstantiated costs, including more than $100,000 in personal expenses.
According to Acting Insurance Fraud Prosecutor Riza Dagli, Victor Napenas, 64, of Piscataway, was sentenced to 30 days in county jail as a condition of three years probation by Superior Court Judge Irvin J. Snyder in Camden County. In addition, Napenas must pay $302,877 in restitution to the Medicaid program, $45,263 in penalties, and $31,859 in provider taxes owed to the state. He will be prohibited from acting as a Medicaid provider for eight years.
The sentence was based on Napenas' Aug. 16 guilty plea to an accusation charging him with third-degree Medicaid fraud. Napenas owned the Valley Rest Nursing Home on Bogart Street in Totowa, which closed in 2007. In pleading guilty, he admitted that he fraudulently obtained payments from Medicaid for personal expenses unrelated to patient care.
The investigation began when Department of Health and Senior Services (DHSS) surveyors noted severe deficiencies in the care delivered to residents at Valley Rest, which resulted in the owners voluntarily closing the facility in 2007. In the process, DHSS ordered a financial audit, which showed many irregularities on the facility's 2005 cost report submitted to Medicaid.
DHSS referred the matter to the Division of Criminal Justice. The Office of the Insurance Fraud Prosecutor's Medicaid Fraud Control Unit worked closely on this investigation with DHSS, in particular the Department's Director of Nursing Facility Rate Setting.
The investigation revealed that the cost report included $302,877 in improper charges, including personal expenses and other amounts Napenas could not document or prove were spent.
Napenas issued business credit cards to himself and his wife through the nursing home, which they used for personal purchases, including trips to the Philippines, dance lessons and large family dinners. Napenas had those credit card charges and other personal expenses totaling more than $100,000 inserted into the cost report, resulting in reimbursement from Medicaid.
"This nursing home owner treated the facility's Medicaid cost report like his own blank check, fraudulently obtaining reimbursement for over $100,000 in personal expenses in a single year," said Acting Insurance Fraud Prosecutor Dagli. "Fortunately, the Department of Health and Senior Services audited the facility and detected irregularities in the cost report. Our Medicaid Fraud Control Unit will continue to work with the Department of Health and Senior Services to uncover and prosecute fraud and abuse involving Medicaid providers."
Deputy Attorney General Linda A. Rinaldi represented the Office of the Insurance Fraud Prosecutor at the sentencing. The case was prosecuted by Deputy Attorney General Rinaldi and Deputy Attorney General Erik Daab, Director of the Medicaid Fraud Control Unit. Sgt. Frederick Weidman, Auditor Kim Geis and Deputy Attorney General Rinaldi conducted the investigation for the Office of the Insurance Fraud Prosecutor.
Attorney General Dow thanked DHSS Director of Rate Setting Devon Graf for the referral and the extensive assistance of his unit throughout the investigation. She also thanked Supervising Investigator Joe Marty of the Division of Taxation for his assistance.
The Medicaid program, which is funded by the state and federal governments, provides health care services and prescription drugs to persons who may not otherwise be able to afford them. The State of New Jersey administers the Medicaid program through the Division of Medical Assistance and Health Services in the Department of Human Services and through the Office of the Insurance Fraud Prosecutor's Medicaid Fraud Control Unit, which investigates both criminal and civil Medicaid fraud and abuse in that program.
A corporate compliance program should be created and maintained in order to best address potential allegations of fraud and abuse by the Medicaid RAC. A compliance program should focus on ensuring compliance in the areas of quality of care, corporate governance, billings, medical necessity, payments, credentialing, hiring, residents' rights and many other areas subject to federal and state compliance.
