N.J. Admin. Code § 10:60C-10.1

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:60C-10.1 - Medicaid fraud and abuse

(a) The Division, and agents thereof, responsible for the administration of the Personal Preference Program shall employ methods, including, but not limited to, offering training, issuing written materials, etc., to identify situations in which a case of fraud and/or abuse in the program may exist.

(b) Any suspected situation of a Medicaid fraud or abuse should be reported immediately to the Division.

(c) The Division shall refer to the Office of State Comptroller, Medicaid Fraud Division (MFD), any situation(s) in which there is valid reason to suspect that Medicaid fraud has or may have been committed in accordance with N.J.A.C. 10:49-9.12.

(d) Willful or knowing acceptance of provider agency services by an applicant approved for participant-directed services, shall constitute fraud and may result in program disenrollment.

(e) Reporting may be performed by contacting the Medicaid Fraud and Abuse hotline at 1-888-937-2835 (toll free), or electronically by using the following website address: http://www.nj.gov/comptroller/divisions/medicaid/complaint.html.

N.J. Admin. Code § 10:60C-10.1

Recodified from 10:142-10.1 by 56 N.J.R. 2294(a), effective 12/2/2024