More than $132 Million in New Jersey Medicaid Funds Recovered, Office of the State Comptroller Announces

TRENTON-More than $132 million in New Jersey Medicaid funds were recovered in fiscal year 2025, a jump of 11 percent from the previous year, the Office of the State Comptroller (OSC) announced today.

Due to efforts by OSC's Medicaid Fund Division, $132,475,474 in Medicaid funds were returned to state and federal budgets in fiscal year 2025, as compared to $119,210,896 in the prior year. The 2025 recovery marks the second-highest amount recouped in the last ten years, with $144,814,560 recovered in fiscal year 2022. In total, OSC has recovered or facilitated the recovery of more than $1 billion in Medicaid funds during the last ten years.

"OSC takes very seriously its responsibility to protect the integrity of New Jersey Medicaid," said Josh Lichtblau, Director of OSC's Medicaid Fraud Division. "Every dollar misspent is money that should have been going towards the care of some of our state's most vulnerable residents."

Through audits, investigations, and reviews, OSC's Medicaid Fraud Division works to identify fraud, waste, or abuse and recoup improper payments. Working with an outside vendor, OSC also works to identify cases in which Medicaid was inappropriately billed and paid for claims that should not have been charged or should have been covered by another payer. Much of the state's Medicaid recoveries are the result of these efforts to obtain repayments for services wrongfully charged to Medicaid when, for instance, a beneficiary resided in another state and the program had paid for that person's coverage or a third-party insurer was responsible. Under federal law, Medicaid is supposed to be the payer of last resort.

Notably, in FY 2025, ten healthcare providers voluntarily notified OSC of having received inappropriate New Jersey Medicaid payments. These providers returned about $1.8 million to the Medicaid program.

OSC encourages providers to report inappropriate payments. Self-disclosing overpayments, in most circumstances, results in a better outcome than if OSC discovered the inappropriate overpayments independently because, among other reasons, OSC will not seek a penalty when it accepts a self-disclosure. From 2019 through 2025, OSC recovered a total of $10,179,588 from 80 healthcare providers who self-reported to OSC. In addition to recouping improperly spent funds, OSC also makes policy recommendations that can prevent wasteful spending of Medicaid funds. For instance, OSC calculated the State saved about $102 million from April 2021 to April 2025, after it adopted OSC's recommendations to curb the use of certain unnecessary and wasteful lab tests.

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To report government fraud, waste, mismanagement, or corruption, file a complaint with OSC or call 1-855-OSC-TIPS.