Dive Brief:
- The federal government has asked New Jersey to repay $32 million in Medicare payments that "did not comply with federal and state requirements" according to an Office of Inspecter General report.
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The report specified the nature of the improper billing.
- Investigators examined a random sample of 100 personal care claims and discovered issues with 17 of those claims, including lack of documentation, lack of nursing assessment and no plan of care, The Hill reports.
Dive Insight:
The 100 claims investigated were just a small fraction of the 18 million that had been submitted from 266 personal care agencies in the state. New Jersey spent a total of $787 million on the claims and received about $400 million in reimbursement from the federal government.
As noted by The Hill, personal care assistance is one of Medicare’s most costly coverage areas. It includes services for the elderly and those with certain disabilities and medical conditions such as bathing, dressing, light housework, medication management, meal preparation and transportation.
This is not the first time the federal government has reviewed New Jersey’s care services program. In 2007 federal officials also discovered a “significant number" of improperly submitted claims for reimbursement.
New Jersey healthcare officials have challenged some of the report's conclusions and its methodology.