The report by the U.S. Department of Health and Human Services’ Office of Inspector General estimated that the state made $721 million in payments that did not comply with federal and state requirements.
New Jersey pays managed care organizations, known as MCOs, to provide long-term services and support to Medicaid beneficiaries living in home and community-based settings, outside of traditional nursing homes.
The audit said that the healthcare providers offered only the most basic of services, and omitted services covered by Medicaid that might have been of benefit, such as physical and occupational therapy, rehabilitation and vision and dental services.
The audit said the failure of those healthcare providers to meet their contracted responsibilities “could have resulted in beneficiaries not getting the services that they needed, and may have put their health and safety at risk.”
Disagreement over Medicaid spending, which is jointly funded by the state and federal government, is not uncommon. In 2017, the state contested another federal audit that charged New Jersey had padded its Medicaid bills by $600 million over a dozen years by seeking reimbursement for public worker pensions that the state never paid and inflating the pay rates. That issue remains unresolved, federal officials said, with the inspector general’s recommendations still “unimplemented.”
An earlier federal audit of Medicaid home and community-based and managed long-term-care services in New York identified similar problems, said the report.
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