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New Jersey Did Not Adequately Oversee Its Medicaid Nonemergency Medical Transportation Brokerage Program

The New Jersey Department of Human Services (State agency) did not adequately oversee its Medicaid nonemergency medical transportation brokerage program to ensure that (1) vehicles used to transport beneficiaries met State standards, (2) drivers were licensed and qualified, (3) prior authorizations were obtained, (4) transportation providers maintained required insurance coverages, (5) beneficiaries received Medicaid-eligible medical services on the date of transportation, and (6) services were documented.

As a result, we estimated that 2,538,674 claims totaling $64.7 million did not comply with certain contract provisions and State requirements. We estimated that 480,290 claims totaling $11.3 million for services during the same period may not have complied with contract provisions and State requirements. In addition, providers' noncompliance with certain contract and State requirements for the licensing and qualifications of vehicle safety and transport personnel could have jeopardized the health and safety of Medicaid beneficiaries.

We recommend that the State agency (a) improve its oversight and monitoring of its Medicaid NEMT brokerage program by requiring LogistiCare, the contractor, to strengthen its procedures to ensure that (1) vehicles used to transport Medicaid beneficiaries meet State requirements, (2) transport personnel are licensed and qualified, (3) prior authorization is obtained and medical necessity documented for beneficiaries who require certain transportation services, (4) transportation providers maintain required insurance coverages, (5) beneficiaries received Medicaid-eligible medical services on the date of transportation, and (6) NEMT services are adequately documented and (b) ensure that its contract with the transportation broker contains provisions that (1) consider improper claims submitted by transportation providers to the transportation broker when developing future capitated rates paid by the State agency and (2) provide a means for the State agency to recoup funds from the transportation broker when contract provisions and State requirements are not met-a measure that, if incorporated, could result in cost savings for the Medicaid program.

In written comments on our draft report, the State agency generally agreed with our first recommendation, did not directly agree or disagree with our second recommendation, and described steps that it has taken to address our findings and recommendations.

Filed under: Centers for Medicare and Medicaid Services