New Jersey’s Medicaid monitoring offices have identified over $1 billion in fraud, overpayments, or wrongful payments during the past decade. The Office of the State Comptroller alone recovered nearly $120 million in the last fiscal year.
Despite these recoveries, acting State Comptroller Kevin Walsh emphasizes that these findings should not undermine Medicaid’s importance, as the program provides essential healthcare for approximately 1.9 million New Jerseyans—about one in five residents.
Currently, there are concerns about potential federal budget cuts to Medicaid. Republicans cite waste, fraud, and abuse as justification, but advocates argue that extensive monitoring systems already effectively target these issues.
The state employs about 70 staff members in its Medicaid fraud unit, which has recovered more than $100 million annually for the past three years. Their work includes following up on nearly 23,000 tips since 2014 and excluding over 2,100 providers from Medicaid participation due to wrongdoing.
Nursing homes and clinical laboratories are the largest targets of fraud investigations. One troubling pattern involves nursing home owners funneling Medicaid funds into other businesses they own while spending little on resident care. In December, officials identified a South Jersey nursing home that directed tens of millions in profits to related businesses while maintaining the worst quality rating in the state.
When the comptroller’s office finds evidence of intentional fraud rather than simple record-keeping errors, cases are referred to the Attorney General’s office. Recent examples include a Kenilworth laboratory that agreed to pay over $13 million after acknowledging routine overcharging and unnecessary testing.
New Jersey currently receives about $19 million in federal funding and $1.8 million in state tax dollars to support these oversight efforts, which have proven effective at protecting both taxpayers and the 1.85 million residents who depend on Medicaid services.
