Evidence record
Estate Recovery Audit Report
- Jurisdiction
- New Jersey
- Publishing agency
- New Jersey Office of the State Auditor
- Publication date
- November 1, 2024
- Source record
- Original document linked
Findings
1
Recommendations
3
Overall conclusion
The division had adequate controls to ensure compliance with federal and state regulations and general information system controls were in place and functioning. However, outdated policies and procedures related to estate recovery led to inconsistent case processing and inadequate case follow-up, and the REC data controls require strengthening to prevent errors and omissions in the data.
Scope
Audit of the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) Office of Legal and Regulatory Affairs, Estate Recovery, covering the period July 1, 2021 to November 1, 2024. The audit reviewed deceased Medicaid beneficiary cases closed between July 1, 2021 and November 20, 2023 that were subject to estate recovery statutes, during which $46.6 million was recovered from 1,399 estate recovery cases. The Recovery Unit tracks estate recovery cases and related payments using the Medicaid Recovery Tracking (REC) system, an Oracle-based in-house developed database. The audit also involved assessment of compliance with federal and state laws and internal criteria, and evaluation of general information system controls, including security management, change management, contingency planning, logical access security, and physical security and environmental controls, in accordance with the Statewide Information Security Manual (SISM).
Findings (1)
Each finding has a stable link.
- F-704
Inconsistencies in Case Processing: The Recovery Unit’s policies and procedures are not comprehensive or sufficiently updated, resulting in inconsistencies in case processing and inadequate case follow-up. Testing of 10 cases from 2,385 closed between July 1, 2021 and November 20, 2023 found 1 case (10%) with no evidence that information was verified or potential recoverable assets were sought; among 1,399 cases with recoveries, 2 cases (20%) lacked adequate support to determine if predeceased spouses were on Medicaid; analysis of liens for cases older than 20 years showed 8 liens had lapsed and 7 cases had no evidence of follow-up.
Recommendations (3)
- R-636
Update and, where necessary, develop formal written operating procedures governing the estate recovery case review process, including case follow-up policies and procedures. Require analysts to document recovery efforts and supporting information during estate recovery case reviews.
Related finding F-704 - R-637
Develop standardized data entry guidelines and implement supervisory reviews to determine completeness and accuracy. Provide training to all system users on proper data entry practices and the importance of maintaining data integrity.
Related finding F-704 - R-638
Configure the Medicaid Recovery Tracking (REC) system to automatically log out idle users after 30 minutes, as required by the Statewide Information Security Manual. Develop and implement a formal disaster recovery plan for the REC system and perform periodic testing once finalized.