NJ’s Medicaid Watchdog Expands Audit and Exclusion Efforts

A recent report from the New Jersey Office of the State Comptroller indicates an expansion of the efforts of its Medicaid Fraud Division (MFD) to investigate fraud, waste and abuse in the New Jersey Medicaid Program. The report also highlights MFD’s expanded effort to exclude providers from the Medicaid Program.

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Providers Beware: Medicare Proposes Harsh New Screening Requirements

The Centers for Medicare & Medicaid Services (CMS) has once again proposed new rules which would enhance the screening requirements for providers and suppliers. The rule proposals would ratchet up the scrutiny on provider enrollments and toughen suspension and revocation penalties.

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Chiropractic Billings Under Government Scrutiny Again

Consistently over the years the Office of Inspector General (OIG) has targeted chiropractic services for audits. In fact, chiropractic services appear annually on the OIG’s workplan agenda. In September 2015, the OIG issued a report recommending that the Centers for Medicare & Medicaid Services’ (CMS) establish better controls and measures to prevent questionable payments, collect overpayments based on inappropriately paid claims and ensure that claims are paid only for Medicare-covered diagnoses.

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Medicaid Audit: Lessons for NJ Personal Care Agencies

The Office of Inspector General (OIG) recently audited New Jersey’s personal care program and found certain deficiencies as a result of noncompliance with Federal and State requirements by some personal care agencies. Based on the audit result, the OIG asked the State to return $32,236,308 in Federal Medicaid reimbursement for personal care services that the OIG claimed did not meet Federal and State requirements.

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A Look Back at NJ Medicaid Fraud Division Activities in 2014

The mission of the Medicaid Fraud Division (MFD) within the Office of the State Comptroller is to prevent, detect, audit and investigate fraud, waste and abuse by New Jersey providers and recipients. As we look forward to the New Jersey Medicaid Fraud Division 2015 work plan, we look back at the agency’s activities in 2014.

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NJSBA Health Law Section Event: Elements of Fraud and Abuse Investigation

Deniza Gertsberg, Esq. will be speaking during “Elements of Fraud and Abuse Investigation” presentation. The event focuses on the basics of a New Jersey Medicaid fraud and abuse investigation. The topics that will be discussed include responding to subpoenas, self disclosure and the use of statistical sampling in audits. The Deputy Director of New Jersey Medicaid Fraud Division, Mark Moskovits and former Director of the Medicaid Fraud Control Unit, Riza I. Dagli will also be presenting. Deniza Gertsberg, Esq. is one of the organizers of this New Jersey State Bar Association event which is open to all members of the NJSBA’s Health Law Section.

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NJ Medicaid Provider Audits: Preparedness Checklists

Every year, the New Jersey Medicaid Fraud Division (MFD), the watchdog agency for New Jersey’s Medicaid program, releases a workplan which informs providers, suppliers and their advisers about the agency’s focus for the up-coming year. MFD’s 2012 workplan outlines a comprehensive audit and review agenda. We have summarized the agency’s audit criteria to help New Jersey Medicaid providers become aware of and stay prepared for scrutiny in 2012.

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NJ Medicaid Enhanced Enrollment Requirements

The Affordable Care Act (ACA) imposed certain enhanced Medicaid enrollment requirements for State Medicaid programs to follow. Recently, the NJ Medicaid Fraud Division Unit (MFD), in consultation with the NJ Division of Medical Assistance and Health Services (DMAHS), described how it plans to comply with the ACA’s enhanced provider screening requirements.

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Get To Know New Jersey Medicaid Auditors

The New Jersey Medicaid and New Jersey FamilyCare programs insures more than one million New Jersey residents. Review responsibilities of the different units within the Medicaid Fraud Division, the State’s “watchdog” agency over these programs.

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