Healthcare Providers Agreed to Repay About $8 Million in Improper Medicaid Payments
The Office of the State Comptroller (OSC) reports 70 providers self-reported the improper payments and agreed to return the Medicaid funds.
TRENTON—Healthcare providers agreed to repay about $8 million in improper Medicaid payments, the Office of the State Comptroller reported today.
Under OSC’s self-disclosure program, providers can notify OSC of inappropriate New Jersey Medicaid payments and return the funds, and OSC may forgive or reduce interest payments and/or extend the repayment schedule.
Self-disclosures accounted for about 11 percent of all improperly spent Medicaid dollars that OSC identified for recovery during fiscal years 2019-2023.
During this period, OSC recovered $73,389,154 from healthcare providers, of which $7,925,231 was due to self-disclosures by 70 providers.
“This is one of the valuable tools that OSC uses to mitigate fraud, waste, and abuse in New Jersey’s Medicaid program,” said Josh Lichtblau, Director of OSC’s Medicaid Fraud Division. “We strongly encourage providers receiving Medicaid funds to investigate, audit, and report any overpayments, as the law requires.”
The Affordable Care Act of 2010 requires Medicaid providers to be proactive about identifying errors and overpayments, and to report and repay overpayments within 60 calendar days of identification. Failure to do so may result in the imposition of fines and penalties. Many providers discover overpayments through their own internal review process or internal compliance reports.
Self-disclosing overpayments, in most circumstances, results in a better outcome than if OSC discovered the inappropriate overpayments independently. OSC may waive penalties and sanctions, as well as offer longer repayment schedules and forgive interest payments.
OSC also recovers Medicaid overpayments from third-party insurers in those instances when Medicaid paid a claim even though the Medicaid recipient had third-party insurance. Medicaid is supposed to be the payer of last resort.
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To report government fraud, waste, mismanagement, or corruption, file a complaint with OSC or call 1-855-OSC-TIPS.
The Office of the State Comptroller (OSC) is an independent State agency that works to make government in New Jersey more efficient, transparent and accountable. OSC is tasked with examining all aspects of government expenditures, conducts audits and investigations of government agencies throughout New Jersey, reviews government contracts, and works to detect and prevent fraud, waste, and abuse in Medicaid.
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