Skip Navigation
United States Flag

An official website of the United States government. Here's how you know >

A New Look for HHS-OIG. Learn More >>

Change Font Size

Audit (A-02-09-01002)

Review of Medicaid Personal Care Claims Submitted by Providers in New Jersey

Executive Summary

We estimated that the State improperly claimed $145.4 million in Federal Medicaid reimbursement for personal care services during our 2004 through 2007 audit period. Of the 100 claims in our random sample, 36 did not comply with Federal and State requirements. Some claims contained more than one deficiency. Deficiencies included no prior authorization, no inservice education for the personal care assistant, no nursing supervision, no documentation of services, no nursing assessment, no certification of the personal care assistant by the New Jersey Board of Nursing, no plan of care, and no physician's authorization.

These deficiencies occurred because the State did not effectively monitor the personal care services program for compliance with certain Federal and State requirements.

We recommended that New Jersey (1) refund $145 million to the Federal Government and (2) improve its monitoring of the personal care services program to help ensure compliance with Federal and State requirements. New Jersey generally disagreed with our recommendations.

Complete Report

Download the complete report

Adobe® Acrobat® is required to read PDF files.

Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201