Report Materials
EXECUTIVE SUMMARY:
Our objective was to determine whether the prescription drug claims for which New Jersey received Federal reimbursement at the enhanced 90-percent rate of Federal financial participation (FFP) qualified as family planning services.
New Jersey improperly received Federal reimbursement at the enhanced 90-percent rate of FFP for 160,995 prescription drug claims that did not qualify as family planning services. As a result, the State improperly received $2,219,746 in Federal Medicaid funds. This amount represents the difference between the enhanced 90-percent rate and the applicable 50-percent or 52.95-percent Federal medical assistance percentage.
We recommended that the State (1) refund $2,219,746 to the Federal Government; (2) review all National Drug Codes (NDC) presently coded as family planning in the Medicaid Management Information System (MMIS) to verify that they are related to family planning; (3) periodically review all NDCs to ensure that they are appropriately coded in the MMIS; and (4) determine the amount of Federal Medicaid funds improperly reimbursed at the 90-percent rate for non-family-planning NDCs, both prior and subsequent to our audit period, and refund that amount to the Federal Government. New Jersey concurred with our findings and recommendations.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.