Mark Anderson, Director, Medicaid Fraud Division
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Decision to terminate Bloomfield Health Pavilion from the Medicaid program upheld by the Appellate Division

October 4, 2010.  Bloomfield Health Pavilion was terminated from the Medicaid program for offering incentives in the form of Pathmark gift certificates for Medicaid recipients to attend its facility in direct violation of N.J.S.A. 30:4D-17(c).  An Administrative Law Judge, and the Director of the Division of Medical Assistance and Health Services both confirmed the termination.  Bloomfield appealed these decisions and in an opinion dated October 4, 2010. the Appellate Division found no reason to disturb these findings and affirmed the decision. 

Administrative Law Judge Affirms Decision to Exclude Doctor from Medicaid Program

September 28, 2010. On September 27, 2010, Administrative Law Judge Mumtaz Bari-Brown upheld the Medicaid Fraud Division's decision to exclude Dr. Magdy Elamir from the Medicaid program for a period of three years.  Dr. Elamir submitted a false Medicaid re-enrollment application in which he failed to disclose that a license he maintained had been suspended.  As a result, the MFD denied his application for re-enrollment.  The Judge upheld this decision in an opinion dated September 27, 2010.

Decision to deny pharmacy into Medicaid program affirmed

June 21, 2010.  Administrative Law Judge Kimberly A. Moss, in an opinion dated June 21, 2010, affirmed DMAHS' decision to deny New Brunswick Pharmacy's application to become a Medicaid provider.  The Office of the State Comptroller's Medicaid Fraud Division's Special Investigations Unit ran a background check on the pharmacy which revealed that the owner submitted a false application.  These findings formed the basis for the denial.

Pharmacy loses appeal of denial of application to become Medicaid Provider

June 8, 2010.  As a result of a background check performed by the Office of the Medicaid Inspector General, the Division of Medical Assistance and Health Services denied Feinstein's Pharmacy's application to be a Medicaid provider and the Office of Administrative Law affirmed this decision in an opinion dated June 7, 2010.  The background check, performed by the OMIG's Special Investigations Unit, revealed that the Board of Pharmacy had previously assessed penalties on the provider due to violations of the Board's regulations.

Adult Medical Day Care Center denial of Medicaid ID number affirmed

June 2, 2010.  The Office of Administrative Law affirmed the Department of Health's denial of Xanadu Adult Medical Day Care Center as Medicaid Provider due to the recommendation of the Office of the Medicaid Inspector General.  Upon a routine background check, the OMIG found that the Administratior of the center failed to reveal a prior conviction.  For the complete opinion, please click here.

Provider denied reinstatement into Medicaid program

May 20, 2010.  On May 19, 2010 Administrative Law Judge Elia A. Pelios dismissed an appeal by Gloria-Thomas McNair challenging the decision of the Division of Medical Assistance and Health Services (DMAHS), based upon an Office of the Medicaid Inspector General investigation, to deny her application for reinstatement to the Medicaid program.    Thomas-McNair had been excluded from the Medicaid program based upon a conviction in federal court unrelated to the Medicaid program for a period of eight years.  The judge concluded that Thomas-McNair had properly been denied reinstatement because she had worked for four different Medicaid providers during her exclusion, in direct violation of the terms of her exclusion.  Based on this, Judge Pelios extended the period of exclusion for an additional eight years.  Click here for the full opinion.

Office of Administrative Law Confirms Denial of Medicaid Pharmacy Provider Application

On September 28, 2009, the Office of Administrative Law confirmed the Division of Medical Assistance and Human Services' decision to deny an application submitted by Oakland Pharmacy to become a Medicaid Provider.  The denial was based on findings of the Investigations Unit of the Office of the Medicaid Inspector that the pharmacy failed to disclose that it was previously subject to disciplinary action.  For more information on this decision, click here.