NJ Medicaid Exclusions

Posted by Frank Strafford on March 15, 2016 in Uncategorized,

Medicaid Exclusion for NJ

Medicaid Exclusion for NJ

New Jersey Medicaid Fraud Division

On June 29, 2010, the duties and functions of the Office of the Medical Inspector General were transferred to the Office of the State Comptroller through the P.L. 2010, Chapter 33, signed by Governor Chris Christie. The Medicaid Fraud Division was then established as the premier initiative of The Office of the State Comptroller.

The Medicaid Fraud Division has three major components:

  1.    Fiscal Integrity Unit is comprised of Audit, Data Mining, Recovery and Exclusion, and Third-party Liability units.
  2.     Investigations Unit focuses on the review and analysis of medical providers’ activities in terms of Medicaid usage.
  3.     Regulatory Unit encompasses an array of functions such as:
  •         Review of provider exclusion and termination
  •         Legal representation of the Division
  •         Support of the Investigations Unit in terms of pending legislations
  •         Proposal of changes to existing regulations.

The Medicaid Fraud Division abides by the rules and regulations outlined in the Medicaid Program Integrity and Protection Act:

For a list of New Jersey Providers and their current standing with the Medicaid Fraud Division, please visit these sites:

http://www.state.nj.us/treasury/debarred

http://www.njinsurancefraud.org/new.htm

New Jersey made it mandatory to search a number of state license databases on a monthly basis, in addition to federal and state exclusion lists. These include:

  • N.J. Treasurer’s exclusions database

http://www.state.nj.us/treasury/debarred/

  • N.J. Division of Consumer Affairs licensure databases

https://newjersey.mylicense.com/verification/

  • N.J. Department of Health and Senior Services licensure database

http://www.state.nj.us/health/healthfacilities/search.shtml

  • Certified nurse aide and personal care assistant registry (mandatory, if applicable)

http://www.nj.gov/health/healthfacilities/ltclicensure.shtml

For general information on New Jersey licensed medical professionals, please see:

http://www.state.nj.us/cgi-bin/consumeraffairs/search/searchentry.pl or http://www.njdoctorlist.com

In a recent study, New Jersey still ranks among the top five states with the most excluded individuals and entities. Through Medicaid Fraud Division’s sustained efforts, citizens of the garden state are assured that none of these individuals/entities are able to participate in the state’s health programs.

For questions regarding self-disclosure, please refer to this link: http://nj.gov/comptroller/divisions/medicaid/disclosure/

Some stats from the LEIE regarding NJ

  • 46 Number of exclusions in 2015 in
    the state of NJ
  • 194 – Number of exclusions in NJ
    from years 2010-2014
  • Among the exclusions 2015 in NJ are nurse/nurse aide, healthcare aide, pain management, counseling, internal medicine, DME – prosthetics & more.

For more on exclusions and state databases, visit our Compliance page.

http://nj.gov/njomig/about/

http://nj.gov/njomig/agency/

http://nj.gov/njomig/disqualified/

http://nj.gov/njomig/about/what/

https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/FraudAbuseforProfs/Downloads/njfy09.pdf

To learn more about State Medicaid compliance, visit our MEDICAID EXCLUSION LIST BY STATE page.

About Frank Strafford

About Frank Strafford

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