Frier Levitt Partner and General Counsel to NJAAP Guillermo Beades has been published in New Jersey Pediatrics Spring 2025 issue, “How Will the Federal Government’s Focus on Medicaid Waste, Fraud, and Abuse Impact Pediatricians in New Jersey?” His article discusses how congress is considering up to $880 billion in Medicaid cuts, with a focus on reducing “waste, fraud, and abuse”—a push that could have serious implications for pediatricians in New Jersey who serve large Medicaid populations. Increased scrutiny and audits from state agencies and managed care organizations (MCOs) are already impacting providers, particularly those with high billing volumes.
While true Medicaid fraud involves intentional deception, abuse and waste can include unintentional billing issues or inefficient use of resources. Unfortunately, enforcement is often inconsistent, putting legitimate providers at risk. Pediatricians are especially vulnerable, as audits frequently target services like sick visits, developmental screenings, and behavioral health—flagging them as “overutilized” even when medically necessary.
The New Jersey Medicaid Fraud Division no longer negotiates overpayment amounts, meaning providers must formally challenge audit findings to reduce penalties. To protect themselves, pediatricians should ensure accurate documentation, regularly review coding practices, and seek legal or compliance guidance before responding to audits.
