Mark Anderson, Director, Medicaid Fraud Division
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OMIG seeks $5.6 million recovery from adult medical day care center

June 9, 2010.  Today, the Office of the Medicaid Inspector General is issuing a report of its findings as a result of its investigation into Garden Adult Medical Day Care Center in Newark, New Jersey.  OMIG seeks $5.6 million from Garden as a result of claims submitted for services not rendered and makes recommendations to the Department of Health regarding the adult medical day care program regulations.  For the full press release, please click here.

Joint venture with Union County leads to guilty plea

May 14, 2010.  Middlesex County resident pleads guilty to theft by deception after joint venture investigation by the Office of the Medicaid Inspector General and the Union County Prosecutor's Office.  For full press release, click here.

Owner of counseling center indicted on Medicaid fraud

May 12, 2010.  As a result of an investigation originating from the Office of the Medicaid Inspector General's Office, the New Jersey Attorney General handed down an indictment today of an owner of a counseling center for defrauding the State's Medicaid program.  Please click here for the full press release.

Home Health Agency Owner Arrested as a result of Office of the Medicaid Inspector General's Investigation

April 26, 2010.  As a result of a joint investgation by the Office of the Medicaid Inspector General and the Medicaid Fraud Control Unit within the State Attorney General's Office, Olasehmdeme "Isaac" Arowosaye, 53, of West Orange, New Jersey, was arrested on fraud charges today.  For the entire press release of the Office of the Medicaid Inspector General, please click here.

Office of Administrative Law affirms decision to withhold Medicaid payment from Campus Pharmacy

March 15, 2010.  On March 15, 2010, Administrative Law Judge Joann LaSala Candido dismissed an appeal by Campus Pharmacy challenging the Division of Medical Assistance and Health Services' (DMAHS) decision, based on the recommendation of the Office of the Medicaid Inspector General, to withhold payment for Medicaid claims for prescriptions Campus dispensed to Medicaid patients between February 20,2008 and June 3, 2008.  Judge LaSala Candido concluded that DMAHS had taken appropriate action during an eleven month prepay monitoring period and had "reliable evidence" of fraud or willful misrepresentation sufficient to withhold Medicaid payments to Campus  For the complete ruling, please click here.

Joint effort with Bergen County Prosecutor's Office results in arrest of FamilyCare recipient

March 5, 2010.  Upon a referral from the Bergen County Welfare Agency, the Office of the Medicaid Inspector General investigated a FamilyCare recipient fraudulently receiving Medicaid benefits and referred the case to the Bergen County Prosecutor's Office for further investigation and potential criminal prosecution.  For more information on the criminal conviction, please see the Bergen County Prosecutor's Office recent press release

Office of the Medicaid Inspector General Featured

February 28, 2010.  In the February 2010 edition of Medicaid Compliance News, the Health Care Compliance Association featured the Office of the Medicaid Inspector General, Mark Anderson, and the Office's accomplishments for its first year.  To view this article, please click here.

Recovery sought from FamilyCare Applicant for Failing to Substantiate Eligibility

February 2, 2010.  The Office of the Medicaid Inspector General is seeking $65,000 from local business owners Brian and Cynthia Hawkins, of Hawks' Towing, for their repeated failure to provide documentation supporting their claim for eligibility into the New Jersey FamilyCare Program.  For the full press release, click here.

Medicaid Inspector General seeks $51.5 million from methadone clinics statewide

December 28, 2009.  Last week, the Office of the Medicaid Inspector General sent Notices of Claim to seven opiate treatment centers in the State of New Jersey putting them on notice of the the Office's intent to seek recovery for fraudulent billings and false claims submitted to the Medicaid program.  Click here for the full press release.

New Jersey Pharmacy terminated from Medicaid Program

December 18, 2009.  Administrative Law Judge Leslie Z. Celentano confirms the Office of the Medicaid Inspector General's decision to terminate Springview Pharmacy from the Medicaid Program.  For the complete decision, click here.

U.S. District Court affirms decision to cap the number of patients at New Jersey's Adult Medical Daycare Centers

December 7, 2009.  In an opinion dated December 7, 2009, United States District Court Judge Stanley R. Chesler dismissed a complaint filed by Buckingham Adult Medical Daycare Center, LLC seeking injunctive relief from the New Jersey Legislature's Fiscal Year 2010 Appropriations Act providing that no licensed facility in the New Jersey Department of Health's Adult Medical Daycare Program may service or receive reimbursement for more than 200 Medicaid recipients per day. 

Administrative Law Judge affirms denial of Medicaid Provider Application

November 25, 2009.  On November 25, 2009, Administrative Law Judge Imre Karaszegi dismissed an appeal brought by Cagans Pharmacy challenging the denial of its Medicaid Provider application.  The denial was based on an investigation conducted by the Special Investigations Unit of the Office of the Medicaid Inspector General identifying that the applicant submitted false information on its application.  For the opinion, click here.  Judge Karaszegi's decision was upheld on December 31, 2009 by final decision of Medicaid Director John Guhl. 

Medicaid Inspector General Mark Anderson Speaks to Healthcare Stakeholders

November 4, 2009.  In cooperation with Seton Hall Law School, Mark Anderson, the New Jersey Medicaid Inspector General, spoke to Healthcare Directors, Providers, and others on November 4, 2009 about the importance of healthcare compliance programs in the current economy, at the "Risks to Directors and Trustees of Health Care & Life Sciences Companies: Corporate Compliance in a Distressed Economy" in Newark, New Jersey.  Click here for a copy of Mr. Anderson's presentation.

Medicaid Inspector General identifies $2.9 million owed the State of New Jersey from Medicaid pharmacy provider

September 29, 2009.  Federally excluded Pharmacist fills New Jersey Medicaid prescriptions despite prohibition.  Click here for full press release.

New Jersey to receive $12 million in Medicaid Fraud Settlement with Pfizer

September 2, 2009.  For more information on this settlement, please visit the Department of Law and Public Safety.

The Division of Medical Assistance and Health Services and Office of Adminstrative Law confirm OMIG denial of Medicaid Pharmacy Provider Application

August 17, 2009.  On August 17, 2009, the Director of the Division of Medical Assistance and Health Services, John Guhl, affirms Administrative Law Judge Ellen S. Bass' decision confirming the Office of the Medicaid Inspector General's decision to deny New Lucy's Pharmacy application to become a Medicaid Pharmacy provider.  Please click here for more information on these decisions.

July 2009 - CMS announces their preliminary findings regarding their Comprehensive Medicaid Integrity Plan for 2009 for New Jersey

July 31, 2009.  After only two months in operation, the Center for Medicare and Medicaid Services conducted an audit of the Office of Medicaid Inspector General and the Department of Medical Assistance and health Services.  We are proud to report that CMS was so impressed with the best practices our Special Projects Unit (SPU) uses to ensure the integrity of the enrollment process into the Medicaid program that CMS is going to recommend our practices be utilized in other Program Integrity units across the country. Some of these accomplishments of our SPU have included preventing 14 pharmacies from enrolling in the Medicaid program because of various concerns including: pending licensing actions by the Board of Pharmacy, failing to disclose required information on applications, pending criminal investigations or actions, and filing applications on behalf of non-operational pharmacies. By preventing these pharmacies from becoming Medicaid providers, we have avoided much potential waste and abuse from getting into the system.

Administrative Law Judge confirms Termination of Medicaid Provider

June 4, 2009.  On June 4, 2009, the Honorable Caridad F. Rigo, ALJ confirmed the Department of Medical Assistance and Human Services' decision to terminate the Medicaid relationship with Be Kind Health Care Services.  This termination was based on investigations by the Office of the Medicaid Inspector General revealing that Be Kind's physicians falsified records and had significant Medicaid billing errors.  Click here for the entire decision.