Review of New Jersey Family Planning Claims for the Period July 1, 1997, Through March 31, 2002

New Jersey did not provide support for $10.9 million ($4.3 million Federal share) of the $13.1 million that it claimed for Medicaid family planning services from July 1, 1997, through March 31, 2002.  Medicaid reimburses the State's family planning services at an enhanced 90-percent rate.  Because we were unable to determine the appropriateness of these claims, we have set aside these costs for resolution by the Centers for Medicare & Medicaid Services (CMS).  Of the $2.2 million in documented claims, the State included $786,000 ($314,000 Federal share) in unallowable costs related to infertility services.  The remaining claims were submitted in compliance with Federal and State requirements.  State officials indicated that they had relied on a consultant to prepare the retroactive family planning claims and that, contrary to Federal requirements, they had not ensured the veracity of those claims.

We recommended that the State:  (1) work with CMS to resolve the $4.3 million in set-aside costs, (2) refund $314,000 to the Federal Government, (3) adhere to Federal and State requirements when submitting family planning claims for Federal reimbursement, and (4) review all work performed by consultants to ensure the veracity of future Medicaid claims to the Federal Government.  The State agreed with our recommendations.