Corporate Compliance

GOV’T AUDIT INSIDER

Healthcare Auditing Weekly, September 7, 2004

New Jersey improperly claimed Medicare reimbursement

New Jersey improperly claimed $3.7 million in contractual services to the Medicaid disproportionate share hospital (DSH) program from April 1, 1997 to June 30, 2001, according to an OIG audit report. The OIG also found that New Jersey relied solely on a contractor (Deloitte Touche Tohmatsu) to prepare and document the claims and did not check the claim's accuracy before submitting them. The OIG recommends that NJ refund the $1.8 million federal share of the reimbursements, review the laws and requirements before submitting claims, and review all work performed by contractors. During the audit, the OIG did the following:

  • Reviewed applicable laws, NJ state plan, and other criteria

  • Reviewed the NJ Office of Management and Budget request for proposal and Deloitte's response

  • Reviewed the contract between Deloitte and NJ Office of Management and Budget

  • Obtained the universe of acute care hospital claims prepared by Deloitte and reconciled the claims to the applicable Medicare program

  • Determined that $110.4 million of claims for 125 health care providers applied to contracts between healthcare providers and state agencies

  • Verified that funds were transferred from NJ to the healthcare providers as a result of the contract services and that these funds were not previously claimed for federal reimbursement

  • Obtained a current list of hospitals classified as DSH eligible, created a list of all providers with DSH claims, and compared the two

    Click here to read the audit report, "Review of Contractual Service Expenditures Claimed by New Jersey to the Disproportionate Share Hospital Program for the Period April 1, 1997 Through June 30, 2001" (A-02-03-01015), issued August 9.

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