The Medicaid Fraud Control Unit performance standards require unit supervisors to perform periodic reviews of all open case files and to note the review in the file. The OIG found 50 percent of the files at the New Jersey unit lacked documentation of periodic supervisory review.
The Medicaid Fraud Control Unit performance standards also require state units to inform the OIG of any individuals convicted of Medicaid fraud within their state within 30 days of the conviction for the purpose of program exclusion. The OIG found New Jersey’s fraud unit failed to send conviction information to the OIG for 94 percent of convicted individuals within the appropriate time frame from 2010 to 2012.
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