New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 49 - ADMINISTRATION MANUAL
Subchapter 13 - PROGRAM CONTROLS
Section 10:49-13.2 - Audits
Universal Citation: NJ Admin Code 10:49-13.2
Current through Register Vol. 56, No. 18, September 16, 2024
(a) A field audit shall be subject to the following:
1.
"Completion of the field audit" for nursing facility providers for purposes of
30:4D-17(f)
shall be defined in the following manner:
i.
For all such audits and audit recovery cases pending on March 1, 1983, it shall
mean the date that field work is completed, or the date information requested
from the provider during the course of that field work is received, whichever
is later.
ii. For all such audits
and audit recovery cases pending on March 1, 1983, which are, have been or will
be referred either to the Legal Action Committee, or to the Division of
Criminal Justice or other agency for criminal investigation, it means the date
the Office of Program Integrity Administration (OPIA) receives authorization to
take administrative action.
iii.
For all such audits initiated on or after March 1, 1983, it means the date the
exit conference is completed or the date information requested from the
provider during the course of the exit conference is received, whichever is
later.
2. "Completion of
the field audit" for all other providers for purposes of
30:4D-17(f)
shall be defined in the following manner:
i.
For all such audits and audit recovery cases pending on March 1, 1983, it means
the date of final screening of the case file by the Assistant Director, OPIA
or, if the case is referred to the Legal Action Committee or the Division of
Criminal Justice, the date OPIA receives authorization to take administrative
action;
ii. For all such audits
initiated on or after March 1, 1983, it means the date of final screening of
the case file by the Assistant Director, OPIA.
3. Notwithstanding any of the previous
subsections, if after the screening of any provider audit initiated on or after
March 1, 1983, the Assistant Director, OPIA, determines with reasonable
justification that an act or omission on the part of the provider requires
additional field work, the field audit shall be considered completed when the
additional field work is completed.
4. Notwithstanding any of the previous
subsections, if after the screening of any provider audit initiated on or after
March 1, 1983, the Assistant Director, OPIA, determines with reasonable
justification that an act or omission on the part of the provider requires that
additional information or documentation be obtained from the provider, then a
completed field audit shall be considered reopened and interest shall again
accrue for the period beginning 20 days from the date the request for such
information or documentation is received by the provider and ending on the date
that all of the requested information or documentation is received by the
agency making the request.
5.
Notwithstanding any of the previous paragraphs, if all or part of any provider
audit initiated on or after March 1, 1983, is referred to the Division of
Criminal Justice or other agency for criminal investigation:
i. In the event no criminal action results
from the referral the field audit shall be considered completed one year from
the date the decision was made to refer the matter for criminal investigation;
and
ii. In the event criminal
action does result from the referral, the field audit shall be considered
completed on the date OPIA receives authorization to take administrative
action.
(b) "Final audit," for purposes of N.J.S.A. 30:4D-7m only, means that point in the audit process when the Division issues to the provider an audit report specifically designated as the "final audit" for a specified period audited.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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