Some of New Jersey's Claims for Medicaid Personal Care Services Did Not Comply With Federal and State Requirements

New Jersey claimed at least $32.2 million in unallowable Medicaid reimbursement for personal care services during the period August 1, 2008, through December 31, 2011. Of the 100 claims in our random sample, 83 claims complied with Federal and State requirements, but 17 claims did not.

The deficiencies occurred because some personal care agencies did not comply with Federal and State requirements. On the basis of our sample results, we estimated that the State agency improperly claimed at least $32.2 million in Federal Medicaid reimbursement for personal care services that did not meet Federal and State requirements.

We recommended that the State agency: refund $32.2 million to the Federal Government and issue guidance to the provider community regarding Federal and State requirements for claiming Medicaid reimbursement for personal care services.

In written comments on our draft report, the State agency partially concurred with our first recommendation and described actions it had taken to address our second recommendation. The State agency also disagreed with our sampling methodology. After reviewing the State agency's comments and additional documentation, including its correspondence with providers, we revised our findings to allow one claim for which the associated records were reportedly damaged by a flood. We maintain that our remaining findings and recommendations are valid.