Office of Inspector General's Partnership Plan - New Jersey Medicaid Selected Programs

EXECUTIVE SUMMARY:

This final report addresses whether financial transactions in New Jersey's Medicaid program were related to selected programs, were reasonable and were properly recorded in the State's accounting system. The audit was made by the New Jersey Office of the State Auditor (OSA) as part of the Office of Inspector General's partnership efforts with State auditors to expand audit coverage of the Medicaid program. The OSA noted several procedural and reimbursement issues needing corrective action. The OSA made a number of recommendations including implementing several prepayment review processes to ensure that services are appropriate, improving prepayment edits, and other procedural recommendations to improve the efficiency of the Medicaid program. The OSA also recommended that the State change its policy regarding outpatient services prior to a hospital stay to coincide with the Federal regulations for Medicare.