In a review of outpatient Medicaid claims for family planning services, the OIG found New Jersey made 43 incorrect claims out of a sample of 107.
Medicaid provides 90 percent reimbursement for family planning services, or services that prevent or delay pregnancy. In the report, the OIG found that the 43 incorrect claims New Jersey made resulted in overpayments of $597,496. The overpayments occurred because either the states Medicaid Management Information System (MMIS) did not have edits to identify improperly coded claims, or clinics improperly billed all services as eligible for the 90 percent family planning reimbursement rate.
The OIG is recommending the state:
- Refund $597,496 to the federal government
- Develop edits in its MMIS to identify all claims that are not eligible for the 90 percent reimbursement rate for family planning services
The state agreed with the OIG’s findings.
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