MedicaidAdministrativeHigh impact
Newsletter Vol. 22, No.11
New Jersey Medicaid·NJ·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid, NJ FamilyCare, and General Assistance programs are implementing enhanced recovery procedures for overpayments made for services dated after a beneficiary's death. The state's fiscal agent (Molina Medicaid Solutions) will automatically void inappropriate payments in the claims system. Providers who submit claims for service dates after a beneficiary's death must conduct a mandatory 3-year self-audit and self-disclose any additional improper claims to the Medicaid Fraud Division.
Action Required
IMMEDIATELY: (1) Billing team must implement processes to verify beneficiary death dates before claim submission. (2) Update claims submission workflows to cross-reference all service dates against state death records to prevent submitting claims for dates after death. (3) Any provider who has submitted claims for service dates after a beneficiary's death must immediately conduct a comprehensive self-audit of all claims submitted in the preceding 3 years to identify all additional improper claims with service dates after dates of death. (4) Billing and compliance staff must determine root cause of improper submissions and implement corrective action to prevent recurrence. (5) Any additional improper claims identified through self-audit must be self-disclosed to the Medicaid Fraud Division (MFD) at http://www.nj.gov/njomig/disclosure/ using their Self-Disclosure Procedure. (6) Document all corrective actions taken and retain for audit purposes. Failure to comply may result in fraud investigations by HMS, MFD, or other state agencies, and potential recovery actions by multiple entities including PAAD and Senior Gold programs.