New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 69 - AFDC-RELATED MEDICAID
Subchapter 9 - OTHER AGENCY RESPONSIBILITIES
Section 10:69-9.17 - County welfare agency responsibility; administrative plan
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The role of the CWA is limited to responsibility for determining whether there is a basis in fact for believing that fraud may have been committed so that referral to the county prosecutor, other proper law enforcement official, or Division of Medical Assistance and Health Services for legal action is justified. The action taken by the law enforcement official following referral determines what further legal action shall be pursued. Whether fraud has actually occurred is a question for the courts.
(b) Each CWA shall develop an operational method to carry out its responsibility that is best suited to its administrative structure and to local conditions and resources. There must be clear allocation of duties and functions in the total process of including investigation, reporting, evaluation, and the decision to refer. In respect to the function of investigation, the CWA may select one or a combination of the following plans:
(c) The CWA shall file with the Division of Medical Assistance and Health Services a detailed description of the administrative plan, and shall advise the division of any subsequent proposed change in the plan before it becomes effective.