To make this determination, the newsletter reinforced the requirement of providers and MCOs to verify any current or prospective employees (regular or temporary), contractors or subcontractors who directly or indirectly will be furnishing, ordering, directing, managing or prescribing items or services in whole or in part are not excluded, unlicensed or uncertified by conducting mandatory monthly searches of several databases, including:

1. State of New Jersey debarment list;
2. Federal exclusions database;
3. N.J. Treasurer’s exclusions database;
4. N.J. Division of Consumer Affairs licensure databases;
5. N.J. Department of Health licensure database; and
6. Certified nurse aide and personal care assistant registry (if applicable)

Providers and MCOs may also conduct searches through the Federal exclusions and licensure database, however this is optional and only certain provider types may access this database.

The newsletter “strongly” recommends that background checks utilizing these databases be included in a provider’s or MCO’s written policies and procedures in order to prevent and detect fraud, waste and abuse.

To read the newsletter in its entirety, click here.

Source: N.J. Dept. of Human Services, Div. of Medical Assistance & Health Services; the N.J. Dept. of Health, Div. of Aging and Community Services; and Office of the State Comptroller, Medicaid Fraud Division, Sept. 2016

Posted: October 20, 2016