By Deniza Gertsberg, Esq., on October 11th, 2016 Under the Affordable Care Act (ACA), providers and suppliers who bill for services furnished by an excluded or an unlicensed person are considered to have received and overpayment from Medicare which must be reported and returned within 60 days of “identifying” the overpayment (claims-based overpayment). New Jersey Medicaid recently reminded providers that a similar requirement for Medicaid and Medicaid Managed Care providers exists in New Jersey and will be enforced.
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By Deniza Gertsberg, Esq., on March 23rd, 2015 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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By Deniza Gertsberg, Esq., on April 21st, 2014 The New York State’s Office of the Medicaid Inspector General (OMIG) has released its program of activities for the current fiscal year. As in previous years, the agency’s audit and investigation function remain strong.
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By Deniza Gertsberg, Esq., on August 27th, 2012 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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By Deniza Gertsberg, Esq., on August 16th, 2012 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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By Deniza Gertsberg, Esq., on April 24th, 2012 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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