According to a new report by state investigators, a New Jersey program designed to help the poor and uninsured get emergency care is being sapped by waste and fraud due to poor oversight by hospitals and state officials. The state currently pays hospitals a portion of the cost of emergency care for some 300,000 poor state residents with no health coverage. This year, the program should spend $583.4 million on charity care, partly drawing on funds from federal sources. The problem is that some people who do have resources are scamming hospitals and the state, such as the man who received $88,000 worth of treatment despite owning a company and making $119,000 a year, the State Commission of Investigation (SCI) said. As a result of such frauds--and a failure to collect money from private insurers or federal health plans--the program is wasting tens of millions of dollars. These problems are occurring because the state departments officially in charge of the charity care program have no real way to detect such frauds, and because hospitals aren't doing a good job of screening, investigators concluded. As a result, the program is a "sitting duck" for fraud. However, a new Medicaid Inspector General will eventually have a role in detecting waste and scams.
To learn more about the situation:
- read this Asbury Park Press article
- read the SCI press release (.pdf)