OIG: New Jersey falsely claimed nearly $95M in Medicaid reimbursement


The New Jersey Department of Human Services failed to comply with federal and state Medicaid billing requirements for a portion of claims reviewed by HHS' Office of the Inspector General for the audit period of Jan. 1, 2009, through Dec. 31, 2012, according to a recent OIG report.

The state agency failed to comply with Medicaid billing requirements for 92 of 100 claims for adult mental health partial care services reviewed by the OIG. Of the 92 noncompliant claims, 19 contained more than one deficiency, according to the OIG. For instance, 84 claims were not documented or supported.

Overall, the OIG estimated that the agency improperly claimed at least $94.8 million in federal Medicaid reimbursement for partial care services that did not meet federal and state requirements.

Based on its findings, the OIG recommended the agency refund the federal government $94.8 million, issue guidance to the partial care provider community on federal and state requirements for claiming Medicaid reimbursement for partial care services and improve its monitoring of partial care providers.

In written comments, the New Jersey Department of Human Services did not agree with the OIG's first recommendation and generally agreed with the remaining recommendations.

After reviewing the New Jersey agency's comments, the OIG maintained its findings and recommendations.


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