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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-02-17-01007
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.

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
3
Questioned Costs
$0
Funds for Better Use
$0
Additional Details
https://oig.hhs.gov/oas/reports/region2/21701007.asp

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
266519 No $0 $0

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.

266518 No $0 $0

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.

266517 No $0 $0

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.

Department of Health & Human Services OIG

United States