December 31, 2009

Audit of New Jersey Department of Human Services, Division of Medical Assistance & Health Services, Fee-For-Service Payments for Managed Care Beneficiaries

The New Jersey Office of Legislative Services, Office of the State Auditor reviewed Medicaid fee-for-service (FFS) payments made between July 1, 2007 and June 30, 2009, on behalf of individuals eligible for Medicaid managed care services. The auditors found that the New Jersey Department of Human Services, Division of Medical Assistance and Health Services paid at least $13 million for hospital and pharmacy services billed as FFS that should have been billed to a Medicaid managed care organization. The majority of problems were linked to difficulties tracking beneficiaries' eligibility.