New York, New Jersey asked to refund millions after OIG audits
Healthcare Auditing Weekly, August 21, 2007
New York and New Jersey each improperly received millions of dollars in Federal Medicaid reimbursements for family planning services, according to a recent OIG audit.
The audit determined New York received $6,132,366 too much for 592,165 prescriptions, while New Jersey was reimbursed an extra $2,219,746 for 160,995 prescriptions. The states received reimbursement at the enhanced 90% rates of federal financed participation qualified for family services. The overpayment amounts represent the difference between the enhanced 90-percent [M4]rate and the applicable 50 % or 52.95 % federal medical assistance percentage (FMAP) in effect in New York and New Jersey at that time. The federal share of the state's Medicaid program is determined by the FMAP.
The OIG recommended both states refund the money and review all National Drug Codes (NDC) presently coded as family planning in the Medicaid Management Information System (MMIS) to verify that they are related to family planning.
New Jersey concurred with the OIG's findings, while New York generally concurred.
To read the audits, click here.
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