Federal Reports

The Connecticut Department of Social Services (State agency) did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group homes reported all critical incidents to the Department of Developmental Services (DDS), (2) DDS recorded all critical incidents reported by group homes, (3) group homes always reported incidents at the correct severity level, (4) DDS collected and reviewed all data on critical incidents, and (5) DDS always reported reasonable suspicions of abuse or neglect.

The New Jersey Office of the State Comptroller, Medicaid Fraud Division, did not always suspend Medicaid payments to providers with credible allegations of fraud in accordance with the Affordable Care Act. Of the 49 providers with credible allegations of fraud that we reviewed, the Medicaid Fraud Division suspended or had good cause not to suspend Medicaid payments to 36 providers. However, it did not initiate proceedings to suspend Medicaid payments to the remaining 13 providers.

Some contract supplies in Round 2 of the Durable Medical Equipment Competitive Bidding Program had not met all of the competitive bidding licensure requirements. Specifically, of the 146 suppliers covered in our audit, 69 suppliers met licensure requirements. However, 63 suppliers did not meet licensure requirements for some of the competitions for which they received a contract. Additionally, 14 suppliers need to be further researched by CMS and its contractors to determine if they met or had not met licensure requirements.