The Office of the State Comptroller Medicaid Fraud Division in consultation with the Ocean County Prosecutor’s Office has announced a pilot program that will enable Ocean County residents who believe they received Medicaid benefits improperly to withdraw from this program without fear of criminal prosecution.
Recipients who participate in the Ocean County Recipient Voluntary Disclosure Program will be required to repay Medicaid for the benefits they received while ineligible and pay an additional civil penalty, based on the amount of improperly received Medicaid benefits. Program participants also must voluntarily withdraw from Medicaid for a one-year period.
The Program will begin on September 12 and conclude on December 12, 2017.
Participants who fully satisfy the Program requirements will not be referred for criminal prosecution for Medicaid-related fraud for the period disclosed by the Program participant. The Ocean County Prosecutor’s Office affirms that it will not take action against Program participants who comply with the settlement terms.
“Our goal is to bring those in Ocean County who were not in compliance with Medicaid eligibility requirements into compliance and to have them make full restitution of all improperly received funds,” said State Comptroller Philip James Degnan. “Residents of Ocean County should consider this Program to be their best opportunity to come into compliance without fear of criminal prosecution.”
MFD Director Josh Lichtblau said, “in addition to bringing residents into compliance, this Program is beneficial because it will return Medicaid funds for use by New Jersey residents who truly are in need of assistance.”
To be eligible to participate in this voluntary Program, the person must:
+be an Ocean County resident;
+be or have been a recipient of Medicaid benefits;
+not have previously entered into a settlement with the OSC;
+not be the subject of a pending State or county criminal matter.
On Tuesday, September 12, OSC will host a public meeting at which Ocean County residents can learn more about this voluntary Program. The meeting will be held at the Pine Belt Arena on the grounds of Toms River North High School, located at 1245 Old Freehold Road in Toms River, beginning at 6:30 p.m. Given the confidential nature of participation in this program, no recording devices, including cameras, will be permitted at the public meeting.
The Program application form and instructions, along with a sample Settlement Agreement, will be posted on the OSC web site, http://www.state.nj.us/
An MFD representative will contact each applicant to obtain follow-up information (if needed), provide restitution and penalty information, and schedule a settlement appointment. Applicants (and their legal representative if they designate one) will then meet with MFD to sign a Settlement Agreement. Settlements will be referred to the State Department of Treasury-Office of Criminal Investigation to determine whether taxes are owed and the Social Security Administration to determine whether SSI benefits must be repaid.
MFD serves as the state’s independent watchdog for New Jersey’s various Medicaid programs and works to ensure that the state’s Medicaid dollars are being spent effectively and efficiently. As part of its oversight role, MFD audits and investigates health care providers, managed care organizations and Medicaid recipients to identify and recover improperly expended Medicaid funds and identify and redress quality of care issues affecting the health of Medicaid recipients.
Suspected Medicaid waste, fraud or abuse can be reported to the MFD by calling its toll-free hotline at (888)937-2835 or by submitting a complaint form located at http://www.state.nj.us/