Review of Medicaid Claims for Patients Between the Ages of 21 to 64 in New Jersey's State Operated Institutions for Mental Diseases Who Were Temporarily Released to Acute Care Hospitals for Medical Treatment

EXECUTIVE SUMMARY:

The objective of this review was to determine if controls were in place to preclude New Jersey from claiming Federal financial participation (FFP) under the Medicaid program for 21 to 64 year old residents of State operated psychiatric hospitals that were institutes for mental diseases (IMDs).  The audit focused on individuals who were temporarily released to acute care hospitals for medical treatment.  Our review found that improvements were needed in controls established by the State to preclude claiming FFP in such cases.  For the period July 1, 1997 through June 30, 2001, the State improperly claimed $190,848 of FFP under the Medicaid program for inpatient acute care hospital services.  We recommended that the State:  (1) refund $190,848 to the Federal Government; (2) identify and return the improper FFP claimed subsequent to June 30, 2001; and (3) strengthen procedures to ensure that claims for 21 to 64 year old residents of IMDs who receive medical services, including inpatient acute care hospital services, provided outside of the psychiatric hospitals, are not claimed for FFP.  New Jersey officials agreed with our recommendations.