FOR IMMEDIATE RELEASE
September 23, 2026
Contact: Jeanette Hoffman – jeanette@marathoncomms.com
New findings indicate New Jersey has failed to revalidate thousands of Medicaid providers as required by federal law
Major Medicaid fraud cases in other states highlight risks when provider oversight and program-integrity safeguards fail
PARSIPPANY, N.J. — The New Jersey Policy Institute (NJPI) is raising concerns that reported failures in New Jersey’s Medicaid provider oversight could leave the state vulnerable to fraud, waste and improper payments while potentially putting significant federal funding at risk.
New findings reported by the Foundation for Government Accountability indicate that New Jersey has failed to revalidate approximately one-third of its 106,982 Medicaid providers within the required five-year period. The findings were based on information obtained from the state through an Open Public Records Act request.
Federal regulations require state Medicaid agencies to revalidate the enrollment of Medicaid providers at least once every five years. The process is an important program-integrity safeguard designed to confirm that providers remain legitimate, properly enrolled and eligible to receive Medicaid payments.
The apparent breakdown in New Jersey comes as federal authorities uncover significant Medicaid fraud schemes elsewhere in the country.
In Minnesota, the U.S. Department of Justice announced charges against 15 defendants in May in health care fraud schemes involving more than $90 million in alleged intended losses. Federal prosecutors alleged schemes involving Medicaid providers billing for services that were never provided, inflating claims, falsifying supporting documentation and, in one case, failing to disclose ownership interests in Medicaid providers.
The federal government has simultaneously increased scrutiny of state Medicaid spending. In July, the U.S. Department of Health and Human Services deferred approximately $867.5 million in federal Medicaid payments to California and $199 million to Minnesota pending additional documentation supporting certain high-risk claims. Those actions were payment deferrals while claims were reviewed, not permanent funding cuts.
“These findings should be a wake-up call for the Sherrill Administration,” said Wells Winegar, Executive Director of the New Jersey Policy Institute. “We have seen what can happen in other states when weaknesses in Medicaid oversight are exploited. Providers billing for services that were never delivered, falsified records and tens of millions of dollars in alleged fraud should make New Jersey especially vigilant about who is receiving Medicaid dollars.”
“Yet New Jersey reportedly has thousands of providers that have not undergone a basic federally required revalidation on time. We do not know whether fraud has occurred among those providers, but that is exactly why the state needs to determine the scope of this problem immediately.”
The reported New Jersey findings indicate that some providers have gone substantially longer than five years without revalidation, including one provider that reportedly had not been checked in more than 12 years. The state reportedly indicated that approximately 200 providers could be in a similar situation.
The potential consequences extend beyond fraud and improper payments. Medicaid is one of the largest sources of federal funding flowing through New Jersey state government, with billions of federal dollars supporting NJ FamilyCare each year. Recent federal actions demonstrate that states can face increased scrutiny and payment deferrals when federal officials identify high-risk claims requiring additional documentation.
NJPI is calling on the Sherrill Administration and the New Jersey Department of Human Services to provide a full accounting of the state’s Medicaid provider revalidation backlog and determine whether the oversight failures have resulted in improper or potentially fraudulent payments.
Specifically, state officials should determine how many Medicaid providers are currently overdue for revalidation, how much those providers have received in Medicaid payments while overdue, whether any overdue providers have subsequently been suspended or terminated from the program, and whether claims associated with those providers warrant additional program-integrity review.
“New Jersey should not wait for a massive fraud case or federal enforcement action to find out whether there are holes in its Medicaid system,” Winegar continued. “Other states have provided a warning of how costly Medicaid fraud can become. The Sherrill Administration should find out exactly who has been receiving taxpayer dollars without timely revalidation, how much they have received and whether those payments were legitimate.”
NJPI is urging state officials to immediately address overdue provider revalidations, review payments made to providers whose revalidations are significantly overdue, strengthen safeguards against fraud and improper payments, and publicly demonstrate that New Jersey is meeting federal Medicaid program-integrity requirements.
