Current through Register Vol. 56, No. 18, September 16, 2024
(a) Subject to
the limitations contained in
42
U.S.C. §
1320a- 7b(a), "Criminal
Penalties for Acts involving Federal Health Care Programs," any violation of
(b) below shall result in the issuance of a Notice of Proposed Termination of
the processing of the applicant's application, or of the beneficiary's
eligibility for NJ FamilyCare. An individual receiving a Notice of Proposed
Termination may request a grievance review.
(b) Subject to the limitations contained in
42
U.S.C. §
1320a- 7b(a), cause for
termination exists when a NJ FamilyCare applicant or beneficiary:
1. Knowingly or intentionally makes or causes
to be made false statements or misrepresentations of material fact in any
application or reapplication for benefits under NJ FamilyCare;
2. Knowingly or intentionally makes or causes
to be made false statements, misrepresentations of material fact, or
alterations on any NJ FamilyCare claim, eligibility card, or other document
issued by or on behalf of the Division;
3. Intentionally misuses or abuses NJ
FamilyCare benefits;
4. Knowingly
or intentionally converts all or part of NJ FamilyCare benefits to a use other
than the individual's own legitimate use and benefit;
5. Gives, loans, or sells an eligibility card
to anyone for use by an individual or individuals other than the eligible
person or persons for whom the card was issued;
6. Engages in forgery or attempted forgery
involving eligible services and/or claims for such services;
7. Engages in a course of conduct or performs
an act deemed improper or abusive of the NJ FamilyCare program following
notification that this conduct should cease; or
8. Fails to cooperate in a NJ FamilyCare
investigation.
(c)
Subject to the limitations contained in
42
U.S.C. §
1320a- 7b(a), the existence of
a cause for termination described in (b) above may be established by:
1. A judgment of conviction for a crime,
disorderly persons offense, or petty disorderly persons offense;
2. A judgment or order of either a court of
competent jurisdiction or an administrative agency; or
3. A preponderance of the evidence.
