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Accession Number
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PB2013-100077
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Title
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New Jersey Generally Reported Medicaid Overpayments in Accordance with Federal Regulations.
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Publication Date
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Sep 2012
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Media Count
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20p
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Personal Author
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N/A
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Abstract
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In New Jersey, the Department of Human Services (State agency) administers the Medicaid program. The State agency uses a statewide surveillance and utilization control program to safeguard against unnecessary or inappropriate use of Medicaid services and excess payments. In March 2009, the State agencys program integrity functions, including audits of Medicaid providers, were transferred to the Office of the Medicaid Inspector General. The Medicaid Fraud Control Unit also conducts audits and investigations of Medicaid providers, and the Department of Health and Senior Services conducts audits of institutional providers. When these agencies identify overpayments, they send letters to the providers that (1) identify the overpayment amount and (2) direct the providers to send payment to the State agency or notify the providers of future payment offsets. Providers are notified of overpayment amounts related to fraud and abuse through settlement agreements and court decisions. Our objective was to determine whether the State agency reported Medicaid overpayments on the CMS-64 in accordance with Federal regulations.
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Keywords
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Audits
Claims
Disabled persons
Health insurance
Low income groups
Medicare
New Jersey
Overpayments
Reimbursement
State agencies
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Source Agency
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Department of Health and Human Services, Washington, DC
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NTIS Subject Category
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43A - Finance
44Q - Health Related Costs
70B - Management Practice
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Corporate Author
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Department of Health and Human Services, Washington, DC. Office of the Inspector General.
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Document Type
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Technical report
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Title Note
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N/A
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NTIS Issue Number
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1303
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Contract Number
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N/A
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