N.J. Admin. Code § 10:167-5.5 - Agency controls

(a) The Commissioner shall establish operating policies within the Department to expedite the processing of applications and assure the maximum possible compliance with the standards set forth in this manual.

(b) The Department has the responsibility for reviewing a statistically valid representative sample of PAAD cases to assure that beneficiary eligibility is determined consistent with State law and eligibility regulations. A quality control review, of sample cases selected on a random basis, includes:

1. Analysis of the beneficiary's case record, including the application, which is maintained by the PAAD Program; and

2. Verification of eligibility factors and third party liability information through collateral contacts.

(c) The Department has the responsibility for monitoring providers participating in the PAAD program, verifying that claims submitted to the program by such providers are in compliance with program regulations, and investigating PAAD beneficiaries in matters involving potential fraud and/or abuse.

(d) The Department shall, as appropriate, recover benefits incorrectly paid on behalf of a PAAD beneficiary.

Notes

N.J. Admin. Code § 10:167-5.5

Amended by R.1998 d.176, effective 4/6/1998.
See: 29 N.J.R. 5280(a), 30 N.J.R. 1314(b).
Amended by R.2009 d.16, effective 1/5/2009.
See: 40 N.J.R. 4479(a), 41 N.J.R. 221(a).