Audit Critical Of HMO Oversight
By Phil Gregory, WBGO News
Trenton. July 31, 2013
A state audit has found that one of the largest HMO’s in New Jersey did not do enough to lower insurance costs by detecting fraud.
United Healthcare Community Plan of New Jersey gets more than $800 million a year to provide healthcare services to state Medicaid recipients.
State Comptroller Matt Boxer says United did not comply with state requirements to aggressively monitor how the money was spent and recovered a low percentage of improper payments made to providers.
“What we found is that on average they were recovering about 800,000 in misspent funds. So that’s less than one tenth of one percent of what they get and pay out.”
Boxer says Medicaid is a ten billion dollar program in New Jersey.
“It of critical importance that the state’s Medicaid HMOs work aggressively to fight fraud in their networks because the program is so big that we can’t do it all alone in this office. We need their help.”
Boxer says United Healthcare officials have agreed to go along with his recommendations to increase the number of employees dedicated to detecting fraud and give them more training.