Gov't audit insider 2/17/04: Consultants make the call on claims, and New Jersey makes restitution.
Healthcare Auditing Weekly, February 17, 2004
The State of New Jersey is taking heat from the Office of Inspector General (OIG) for submitting $22.2 million in state prison inmate health care claims for federal reimbursement under the disproportionate share hospital program (DSH).
The state must make restitution on ever penny it received for the inmates' claims made under the DSH program, the OIG says. New Jersey relied on Deloitte Consulting to maximize statewide federal reimbursement, but the government says the consulting firms' submission of DSH-related inmate acute care hospital costs from 1996 to 2001 is not allowed.
The audit didn't look at the New Jersey's overall internal control structure, but instead conducted a "limited assessment" of fiscal controls related to DSH claims for federal reimbursement.
The OIG did the following during the audit:
Despite state Medicaid program requirements, state officials had not reviewed the claims before submission for federal reimbursement, says the OIG. The OIG recommended that state officials make sure that work done by consultants is accurate. Does your hospital contract out claims submission? Do you know what's being sent to the government from your facility?
To view the OIG audit, called "Review of acute care hospital prison inmate expenditures claimed by New Jersey to the hospital program for the disproportionate share," click here.
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