Second Medicaid Taken to Task for Lax Oversight of Fraud Protection

For the second time in two years, State Comptroller Matthew Boxer has found that a company that manages Medicaid patient care for the state is failing in its responsibility to oversee fraud prevention efforts.

Boxer’s office released a report yesterday criticizing UnitedHealthCare for failing to hire or train the appropriate number of fraud investigators required by its contract with the state. Their efforts recovered only $1.6 million in improper payments, representing less than a tenth of a percent of the $1.7 billion state Medicaid premium payments to the company.

The audit covered the years 2009 and 2010 – the same time period for which Horizon Blue Cross Blue Shield was criticized in a similar report released in 2011.

“With billions of tax dollars flowing through New Jersey’s Medicaid program, our state relies on its Medicaid HMOs to fulfill their oversight responsibilities in an aggressive manner,” Boxer said in a statement. “This is another audit that shows an HMO failing to live up to requirements designed to combat fraud and lower state Medicaid costs.”

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