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WHEREAS, fraud
exists in all corners of the health marketplace and is perpetrated
on and by consumers, health care facilities, practitioners, insurance
companies and others. Nationally, as much as 50*billion health care
dollars are lost each year to fraud in various forms, including
false claims, fraudulent subcontracts, unreliable billing practices,
excessive salaries, bribery, tax evasion and kickbacks; and
WHEREAS, ultimately
the members of the public, as consumers and taxpayers, bear the
cost of these fraudulent activities since providers and insurers
shift the cost to government, employers and to those who can afford
insurance, while too often the poorest members of society are left
with inadequate medical services; and
WHEREAS, health
care is a large and profitable business and presents a significant
opportunity for financial gain in which any lack of effective regulatory
and legal controls and enforcement mechanism invites fraud; and
WHEREAS, New
Jersey cannot wait for the conclusion of the national dialogue to
decide how best to allocate scarce health care resources, achieve
access to quality care for all New Jersey citizens and rid the marketplace
of fraud; and
WHEREAS, New
Jersey must ensure that its regulatory and legal efforts are as
strong and effective as possible in both preventing health care
fraud and in identifying and prosecuting such fraud where it exists;
and
WHEREAS, there
have been enforcement successes in the ongoing battle against health
care fraud, including the investigation and prosecution of alleged
broad based schemes involving fraudulent insurance claims submitted
by health care providers and others to private insurance companies,
self-funded insurance programs and the Medicaid program. More, however,
needs to be done; and
WHEREAS, health
care fraud will be better policed by a broad "systematic" approach
and greater coordination of prevention and enforcement efforts;
NOW, THEREFORE,
I, CHRISTINE TODD WHITMAN, Governor of the State of New Jersey,
by virtue of the authority vested in me by the Constitution and
by the Statutes of this State, do hereby ORDER and DIRECT:
1. The establishment
of the Health Care Fraud Task Force (the "Task Force"), which
shall function as the policy development body for the Executive
Branch in establishing a comprehensive health care fraud enforcement
plan.
2. The Task
Force shall identify and catalogue the forms of health care fraud
existing within the New Jersey marketplace and identify all Executive
Branch agencies and resources currently involved or which should
be involved in health care fraud prevention and enforcement.
3. The Task
Force shall identify priority prevention and enforcement areas,
as well as design and implement coordination strategies among
all Executive Branch agencies for the centralized investigation
and prosecution of all civil and criminal cases involving significant
or widespread fraud in the health care industry, as well as strategies
for the effective handling and disposition of other cases.
4. The Task
Force shall develop and recommend an Executive Branch budget for
the support of a comprehensive and effective health care fraud
prevention and enforcement strategy from existing resources and
identify emerging technologies necessary for an effective and
comprehensive strategy.
5. The Task
Force shall design and implement measures (1) to educate the public
and health care industry, and in particular to eliminate their
tolerance of health care fraud and (2) to reduce the opportunities
for individual gain through fraudulent health care practices.
6. The Task
Force shall develop ongoing outreach activities with the industries
and professions which make up the health care delivery system
to insure that the needs and concerns of those entities are reflected
in the comprehensive health care fraud enforcement plan.
7. Finally,
the Task Force shall identify statutory, regulatory and administrative
changes or improvements related to health care fraud prevention
and enforcement.
8. The Task
Force shall consist of the Attorney General, who shall serve as
chairperson of the Task Force; the Treasurer; the Commissioner
of Health; the Commissioner of Insurance; and the Commissioner
of Human Services.
9. The Task
Force shall report to me periodically regarding its progress in
establishing a comprehensive health care fraud enforcement plan.
The first report shall be issued no later than six months following
the date of this Order, and the second report no later than one
year following the date of this Order. Subsequent reports as to
status of the plan shall be issued every year thereafter.
10. This
Order shall take effect immediately.
GIVEN,
under my hand and seal
this 28th day of May in the Year
of Our Lord, One Thousand Nine
Hundred and Ninety-Six, and of the
Independence of the United States,
the Two Hundred and Nineteenth.
/s/
Christine Todd Whitman
Governor
Attest:
/s/ Harriet
Derman
Chief Counsel to the Governor
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