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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-02-17-01018
Report Description

New Jersey pays managed care organizations (MCOs) to make managed long-term services and supports (MLTSS) available to Medicaid beneficiaries in home and community-based settings. Recent OIG audits of Medicaid home and community-based and managed long-term-care services identified significant vulnerabilities. Therefore, we decided to audit payments in New Jersey for the provision of similar Medicaid services.

Report Type
Audit
Location

NJ
United States

Number of Recommendations
2
Questioned Costs
$0
Funds for Better Use
$385,867,495
Additional Details
https://oig.hhs.gov/oas/reports/region2/21701018.asp
External Entity
State of New Jersey

Open Recommendations

This report has 2 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
268923 No $0 $0

We recommend that the New Jersey Department of Human Services improve its monitoring and follow-up activities to ensure that its MCOs comply with Federal and State requirements detailed in its contracts with the MCOs for providing services to beneficiaries according to personalized care plans and actively coordinating, monitoring, and documenting beneficiaries’ physical health, behavioral health, and long-term-care needs.

268924 No $0 $385,867,495

We recommend that the New Jersey Department of Human Services take actions, including imposing corrective action plans, fines, or other financial disincentives on MCOs, to address the MCOs’ noncompliance affecting $721 million ($386 million Federal share) in capitation payments in CY 2016 and ensure future compliance with contract requirements.

Department of Health & Human Services OIG

United States