N.J. Admin. Code § 11:6-2.11

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

Section 11:6-2.11 - WCMCO fraud detection plan

(a) The WCMCO shall establish and implement a comprehensive fraud detection plan for identifying and reporting instances of possible fraud on the part of injured workers, employers, medical providers and others.

(b) The WCMCO fraud detection plan shall consist of a written plan that is reviewed at least annually and revised as necessary, and which shall include, but not be limited to:

1. Identification of items that trigger investigation into fraud and abuse;

2. Identification of frequent fraud areas and methods for detecting fraud;

3. Mechanisms for receiving input on worker, employer and provider problems and concerns regarding fraud or abuse; and

4. Procedures for investigating and reporting suspected fraud.

(c) The WCMCO shall coordinate its fraud detection plan with the workers' compensation insurer's fraud prevention plan, where appropriate.

N.J. Admin. Code § 11:6-2.11

New Rule, R.2004 d.41, effective 1/20/2004.
See: 35 New Jersey Register 3541(a), 36 New Jersey Register 520(a).