Weinberg On Oversight Of Medicaid Fraud -– ‘Totally Unacceptable’

Says Horizon, State Department of Human Services Dropped the Ball on Exposing Fraud, Recovering Fraudulent Payments

TRENTON – State Senator Loretta Weinberg, D-Bergen, the Chairwoman of the Senate Health, Human Services and Senior Citizens Committee, issued the following statement today regarding two independent investigations this week revealing lax oversight of Medicaid fraud and overspending in New Jersey:

“The reported lax oversight and overspending of the State’s Medicaid investment is totally unacceptable at a time when New Jersey residents are struggling to make ends meet. With Governor Christie putting Medicaid in his budgetary crosshairs during each of his previous budgets, we need to make sure this program is operating at maximum efficiency, to help the greatest number of people possible access health care services.

“The Comptroller’s report, detailing a complete breakdown of Horizon’s Medicaid fraud investigation program, shows that the company has failed to live up to its oversight responsibilities under the current contract. Considering that Horizon is the largest Medicaid provider in the State of New Jersey, they should be doing a much better job of rooting out abuse and recovering fraudulent payments. Beyond that, the company has failed to reimburse the State for the total amount owed for premiums paid out for fraudulent claims.

“In a two year time period, Horizon only recovered $188,000 in a program which receives $1.3 billion a year in State tax dollars. Considering that the national rate of Medicaid fraud is around 3 percent, the one-tenth of one percent Horizon was able to recover indicates that someone was asleep at the switch. I hope that the Comptroller reviews Medicaid spending prior to 2009 to reveal whether or not the oversight breakdown is a long-standing problem.

“In addition to the Comptroller’s review, the State Auditor found that the Department of Human Services overpaid for hearing aids, drug tests and other medical equipment. The funds wasted on inflated reimbursements or duplicative services could have been put to much better use helping an uninsured person access basic medical care.

“Medicaid fraud and overspending are rampant in New Jersey and throughout the rest of the country, and if we’re serious about allowing all Americans access to decent, affordable health care, we have to crack down on the systemic problems which result in wasted tax dollars and higher out-of-pocket expenses for tax-paying New Jerseyans. It’s time for the State and its vendors to get serious about improving Medicaid efficiency.”