Health maintenance organization’s Medicaid recovery audits found lacking

According to a recently released audit by the Office of the State Comptroller of New Jersey, recoveries made by the state's largest Medicaid health maintenance organization are lagging.

Investigators found that in 2009 and 2010, recovery audits launched by Horizon NJ Health (HNJH) recouped less than one-tenth of 1 percent of the $1.3 billion it receives from the state annually.

"The bottom line is we pay a lot of money as a state to Horizon and the state is getting less than what it bargained for in its contract," said Mark Anderson, director of the OSC Medicaid fraud division.

State Comptroller Matthew Boxer called on the organization to "step up its efforts in investigating Medicaid fraud and abuse and recovering misspent Medicaid dollars." He noted that improving recovery audit recoupments is especially important during the state's transition from its Medicaid program to a managed care system.

Earlier this year, the state was praised for launching its Medicaid RAC program ahead of schedule, Martindale reports. Since the beginning of August, Health Management Systems has been conducting both automated and complex reviews. 

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