TRENTON—The Office of the State Comptroller released an audit today that shows a New Jersey mental health provider improperly billed and was paid more than $1.7 million in Medicaid funds. OSC is seeking repayment in full from Sokkyun Yi, a Princeton-based licensed social worker who provides intensive in-community mental health services in New Jersey.

As part of its oversight of the New Jersey Medicaid program, OSC’s Medicaid Fraud Division conducted an audit of Medicaid claims submitted by and paid to Sokkyun Yi for the period from September 21, 2016 through March 2, 2020 for services provided by Yi and others with whom Yi contracts.

Yi does business under the name Family First Counseling Services.

OSC’s audit found that more than half (54 percent) of the 963 claims reviewed contained deficiencies. Among the deficiencies found:

• Inaccurate and inadequate documentation. Of 963 claims reviewed, 311 had inaccurate documentation. In some cases, forms also were missing pages and/or required signatures.
• “Upcoding” claims. OSC found 18 claims in which Yi billed (and was paid) for a higher-level, higher-paying service than was actually provided.
• Improper billing for travel time or for overlapping services. In some cases, Yi billed for services provided by one professional at the same time for different Medicaid beneficiaries.
• Failing to ensure behavioral assistants met the minimum standards set by New Jersey Medicaid. Yi, for instance, was unable to provide OSC with copies of high school diplomas or equivalents for six of the 15 behavioral assistants in the audit sample. Yi also allowed four behavioral assistants to provide services without having received the appropriate training and certification. One behavioral assistant was permitted to work without the requisite proof of successfully completing a criminal background check.

“Providers who receive New Jersey Medicaid dollars have a legal obligation to comply with these requirements. OSC will continue to audit providers to ensure that Medicaid beneficiaries receive the services that New Jersey pays for and that taxpayer dollars are not improperly spent,” said Joshua Lichtblau, Director of OSC’s Medicaid Fraud Division.

OSC seeks to recover $1,795,277 from Yi, and it is recommending that Yi implement several corrective actions to address the deficiencies identified in this report.

Read the report.

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To report government fraud, waste, mismanagement, or corruption, file a complaint with OSC or call 1-855-OSC-TIPS.