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

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.

Centers for Medicare and Medicaid Services