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Audit (A-02-10-01009)

09-24-2012
New Jersey Generally Reported Medicaid Overpayments in Accordance With Federal Regulations

Executive Summary

The New Jersey Department of Human Services (State agency) generally reported Medicaid overpayments in accordance with Federal requirements. However, it did not report all of them in accordance with Federal requirements. For Federal fiscal years 2008 and 2009, the State agency did not report Medicaid overpayments totaling $2.8 million ($1.4 million Federal share) in accordance with Federal requirements. Federal law requires the State to refund the Federal share of a Medicaid overpayment. Implementing regulations require the State agency to refund the Federal share of an overpayment to a provider at the end of the 60-day period following the date of discovery, whether or not the State agency has recovered the overpayment.

Of the 180 overpayments we reviewed, 14 were partially reported or not reported on Form CMS-64, Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program. The remaining 166 were reported correctly. The State agency also did not report all Medicaid provider overpayments within the 60-day time requirement. The State agency did not properly report these overpayments because it had not developed and implemented policies to ensure that overpayments were reported on the correct CMS-64.

We recommended that the State agency (1) include unreported Medicaid overpayments of $2.8 million on the CMS-64 and refund $1.4 million to the Federal Government and (2) develop and implement policies to ensure that future Medicaid overpayments are reported on the correct CMS-64 in accordance with Federal requirements. The State agency partially agreed with our first recommendation and concurred with our second recommendation.

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