MedicaidAdministrativeHigh impact
Newsletter Vol. 33, No.02
New Jersey Medicaid·NJ·Provider Notice
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
New Jersey requires all healthcare providers and MCOs to conduct monthly background checks on all employees and contractors (current and prospective) who furnish, order, direct, manage, or prescribe services to ensure they are not excluded, unlicensed, or uncertified individuals. Providers must search five mandatory databases and report any excluded individuals to the State Comptroller. Non-compliance may result in claim denials, recovery demands, and civil penalties.
Action Required
REQUIREMENTS:
By April 2023 (immediately): Implement monthly verification procedures for all current and prospective employees, contractors, and subcontractors who provide services billed to New Jersey Medicaid, NJ FamilyCare, or PAAD programs. Billing team must establish and document a process to search the following databases monthly:
1. State of New Jersey debarment list (https://nj.gov/comptroller/doc/nj_debarment_list.pdf)
2. Federal exclusions database (https://exclusions.oig.hhs.gov/)
3. N.J. Treasurer's exclusions database (http://www.state.nj.us/treasury/revenue/debarment/debarsearch.shtml)
4. N.J. Division of Consumer Affairs licensure databases (http://www.njconsumeraffairs.gov/Pages/verification.aspx)
5. N.J. Department of Health licensure and certification database (https://njna.psiexams.com/)
Integrate these verification checks into your written fraud prevention and compliance policies. Designate staff responsible for conducting monthly searches and maintaining documentation of verification results.
If any excluded, unlicensed, or uncertified individual is discovered: Send written notification immediately to Office of State Comptroller, Medicaid Fraud Division, P.O. Box 025, Trenton, NJ 08625-0025. Report fraud/abuse to 1-888-937-2835 or https://www.nj.gov/comptroller/about/work/medicaid/complaint.shtml.
CONSEQUENCES: The State reserves the right to deny, void, or seek recovery for any services furnished by excluded individuals. Interest and civil penalties will be assessed. Non-compliance violates Federal Deficit Reduction Act Section 6032.