Fed finds problems with N.J.’s Medicaid billing, wants $95 million refund

A federal audit claims New Jersey officials have not done enough to monitor the billing practices of community-based organizations that treat outpatients with serious mental illness. It’s calling for the the state to refund nearly $95 million for federally funded Medicaid services it says were not properly documented.

The U.S. Department of Health and Human Services’ Office of Inspector General said the review was prompted in part by earlier findings, published in 2012, that suggested the state needed to beef up oversight of its Medicaid claims process and clarify the guidance it gives providers. The latest report, announced in late December, included an analysis of 100 claims randomly selected from the nearly 3.9 million bills submitted from 2009 through 2011. The OIG found only eight of these 100 claims met all state and federal requirements.

State officials and local providers contest findings, say they are based mainly on ‘unreasonable’ requirements for documentation of treatments

Read the full story at NJ.com: Federal Audit Finds Problems with NJ’s Medicaid Billing System, Wants $95M Refund – NJ Spotlight