TRENTON, N.J. (AP) — Federal officials are asking for a $30 million refund from New Jersey after an audit found that adult mental health services providers in the state did not make Medicaid claims in accordance with state and federal standards.
The report from the U.S. Health and Human Services Department's inspector general was released Thursday.
The report, which examined services provided in group homes, supervised apartments and family care homes, was based on 100 random claims sampled by investigators. It found 64 did not comply with standards, and 24 had more than one deficiency.
It also found that for 32 of the claims, staff did not meet education and training requirements; for 23, service plan requirements weren't met; and for 15, the provider's staffing levels were not consistent with required level of care, or the providers claimed a higher level of care than was recommended.
The report found in other instances weekly progress notes were not documented; face-to-face visits were not completed; services were not documented, supported or allowable; and nursing assessment requirements were not met.
The report estimated providers in the state improperly claimed more than $30 million from the federal government from June 2005 to December 2007. The report also recommended the state provide guidance to providers and improve its monitoring of claims.
In a written response to the report, the New Jersey Department of Human Services agreed with some of the findings but questioned the accuracy of others. It also provided additional documentation and explanations for some claims.
The department specifically questioned why only 100 of more than 500,000 claims were sampled, and questioned the methodology for arriving at the $30 million refund figure.
But the department agreed monitoring of providers can be improved, and has begun providing technical assistance to providers as a result of the audit.