CONAWAY: LACK OF MEDICAID FRAUD OVERSIGHT DEMANDS BETTER REGULATION METHOD

(7th DISTRICT) – Assembly Health and Senior Services Chairman Herb Conaway M.D. released the following statement Wednesday concerning the audit released by the state comptroller this week that revealed a failure of oversight and regulation of Medicaid fraud by Horizon NJ Health:

“The findings in this audit are an affront to the taxpayers of New Jersey who are footing the $1.3 billion that Horizon NJ Health receives annually as a Medicaid provider.

“While its contract with the state requires it to maintain a special investigations unit dedicated to detecting fraud and abuse, Horizon NJ Health identified only $188,207 in improper payments of the $1.3 billion it received from the state to pay claims during a two-year period.

“It seems to me that the fox is guarding the hen house.

“It’s imperative that we have the proper oversight to ensure taxpayers are getting what they paid for. The federal government recently started using predictive modeling software to combat Medicare fraud. The fraud detection tool works to reduce improper payouts by flagging fraud before payments are made, similar to technology used by credit card companies.

“We owe it to the taxpayers to consider applying this technology here in New Jersey. Unlike Horizon with its conflicting incentives, a third-party vendor’s only incentive would be to find and prevent as much fraudulent activity as possible. That’s a big win for taxpayers.

“This would result in lower insurance costs paid by the state, and the savings could be used to ensure hard-pressed residents get access to life-saving healthcare.”