TRENTON — State investigators reclaimed $116 million in Medicaid funds over the last fiscal year that was improperly paid to insurance companies, pharmacies and adult medical day care providers, state Comptroller A. Matthew Boxer said Wednesday. The Comptroller’s Medicaid Fraud Division recovered the money after determining the program had paid for services never provided, was billed by professionals banned...
NJ State Comptroller Matthew Boxer testifies before the NJ Senate Legislative Oversight Committee in this 2010 file photo. Boxer announced Wednesday that a state investigation reclaimed $116M in improperly paid Medicaid funds.TRENTON — State investigators reclaimed $116 million in Medicaid funds over the last fiscal year that was improperly paid to insurance companies, pharmacies and adult medical day care providers, state Comptroller A. Matthew Boxer said Wednesday.
The Comptroller’s Medicaid Fraud Division recovered the money after determining the program had paid for services never provided, was billed by professionals banned from the program because of past problems, or was inappropriately charged to the program, according to Boxer’s announcement.
The recovered funds have been split between the state and federal Medicaid coffers, said Pete McAleer, Boxer’s spokesman.
The largest single amount — $25 million — came from Horizon Blue Cross Blue Shield of New Jersey, the largest insurance company in the state, McAleer said. Medicaid paid for treatment that Horizon had an obligation to cover as the person’s primary insurance provider.
"The problem lies in the fact Horizon has not updated its computer system and is not able to determine or detect when Medicaid funds were used to pay claims that should have been paid by Horizon,’’ McAleer added.
Horizon spokesman Thomas Vincz called McAleer’s characterization "an overbroad and inaccurate statement. Horizon has actually experienced multiple issues with transmitting information to the vendor used by the state to reconcile these claims.’’
The $25 million Horizon paid is based on estimates of claims from 2002 to 2007, and the insurer expects to see some of that money returned when a more thorough audit is done, Vincz added.
Among the other actions taken, the comptroller recovered $1.6 million from Garden Adult Medical Day Care in Newark, for services it could not prove it had provided; and $900,000 from a CVS Pharmacy in Freehold for employing a pharmacist who had been banned from the Medicaid program.
New Jersey spends about $4.4 billion on Medicaid, the health insurance program serving about 1.3 million people low-income and disabled people.
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