New Jersey Did Not Provide Adequate Oversight of Its Medicaid Delivery System Reform Incentive Payment Program

Submitting OIG:

Department of Health & Human Services OIG

Report Description:

We could not determine whether New Jersey appropriately claimed Medicaid reimbursement for pay-for-performance incentive payments to five selected hospitals. Specifically, we could not determine if the hospitals met performance goals calculated from Medicaid claims data. In addition, the hospitals did not report patients' health records information consistent with performance measure criteria. As a result, we could not determine what portion of pay-for-performance incentive payments, totaling approximately $51 million ($25 million Federal share), that New Jersey made to the five selected hospitals based on determinations from New Jersey's Delivery System Reform Incentive Payment (DSRIP) program contractor was appropriate.

Date Issued:

Monday, March 25, 2019

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-02-17-01007

Component, if applicable:

Centers for Medicare & Medicaid Services

Location(s):

Agency-Wide

Type of Report:

Audit

Questioned Costs:

Funds for Better Use:

Number of Recommendations:

View Document:

Attachment	Size
21701007.pdf	2.13 MB

Additional Details Link:

https://oig.hhs.gov/oas/reports/region2/21701007.asp

Recommendation Number	Recommendation Status	Significant Recommendation
266517	Open	No
We recommend that the State agency work with DOH, the DSRIP program contractor, and the five selected hospitals to determine whether the $50,920,788 ($25,460,394 Federal share) in pay-for performance incentive payments to the five hospitals was appropriate.
266518	Open	No
We recommend that the State agency work with DOH, the DSRIP program contractor, and the 44 hospitals not covered by this review to determine whether the $131,511,277 ($65,755,639 Federal share) in pay-for-performance incentive payments to those hospitals was appropriate.
266519	Open	No
We recommend that the State agency improve its oversight of the DSRIP program to ensure that (1) its contractor maintains the Medicaid claims data necessary to support its determinations for whether hospitals qualify for pay-for-performance incentive payments and (2) hospitals report information consistent with the performance measure criteria to the DSRIP program contractor.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

266517

Open

We recommend that the State agency work with DOH, the DSRIP program contractor, and the five selected hospitals to determine whether the $50,920,788 ($25,460,394 Federal share) in pay-for performance incentive payments to the five hospitals was appropriate.

266518

Open

We recommend that the State agency work with DOH, the DSRIP program contractor, and the 44 hospitals not covered by this review to determine whether the $131,511,277 ($65,755,639 Federal share) in pay-for-performance incentive payments to those hospitals was appropriate.

266519

Open