Charity Care Fraud and Abuse (NJ DOH)
| Submitted | Jan. 12, 2018 |
| Est. Completion | None |
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Communications
From: Anthony Santora
To Whom It May Concern:
Pursuant to Open Public Records Act ("OPRA"), I hereby request the following records:
(1) Documents or records sufficient as to identify all complaints of Charity Care fraud, waste and abuse received from 2013 through 2017.
(2) Documents or records sufficient as to identify all complaints of Charity Care fraud, waste and abuse referred to the Office of the State Comptroller, Medicaid Fraud Division from 2013 through 2017.
(3) Documents or records sufficient as to identify the total amount of funds recovered and deposited into the Charity Care fund as a result of a fraud, waste or abuse investigation or audit conducted from 2013 through 2017.
(4) Documents or records sufficient as to identify all policies, procedures, directives, and/or guidelines related to Charity Care fraud, waste or abuse.
The requested documents will be made available to the general public, and this request is not being made for commercial purposes.
In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.
Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 7 business days, as the statute requires.
Sincerely,
Anthony Santora
From: Department of Health
Dear Mr. Santora,
This will respond on behalf of the Office of the Commissioner. Your request is improper and overbroad. "The requestor must identify the records sought with specificity. The request may not be a broad, generic description of documents that requires the custodian to search the agency's files and 'analyze, compile and collate' the requested information." Bart v. Passaic County Public Housing Agency, 406 N.J. Super. 445, 451 (App. Div. 2009). If a request does not name specifically identifiable records or is overly broad, a custodian may deny access pursuant to well-established case law. See MAG Entertainment, LLC v. Division of Alcoholic Beverage Control, 375 N.J. Super. 534 (App. Div. 2005); Bent v. Twp. of Stafford Police Dept. Custodian of Records, 381 N.J. Super. 30 (App. Div. 2005); N.J. Builders Ass'n v. New Jersey Council on Affordable Housing, 390 N.J. Super. 166 (App. Div. 2007); Schuler v. Borough of Bloomsbury, GRC Complaint No. 2007-151 (February 2009).
OPRA does not countenance "[w]holesale requests for general information," MAG, supra, 375 N.J. Super. at 549 or open-ended demands "for every document a public agency has on file." Bent, supra, 381 N.J. Super. at 37. Rather, "OPRA requires a party requesting access to a public record to specifically describe the document sought," Gannett New Jersey Partners, L.P. v. County of Middlesex, 379 N.J. Super. 205, 212 (App. Div. 2005), so that the records may be readily and reasonably identified within the short time frame within which government custodians must respond. Bent, supra, 381 N.J. Super. at 36-37. "As such, a proper request under OPRA must identify with reasonable clarity those documents that are desired, and a party cannot satisfy this requirement by simply requesting all of an agency's documents." Ibid.
Under OPRA "agencies are only obligated to disclose identifiable government records." Burke v. Brandes, 429 N.J. Super. 169, 174 (App. Div. 2012), citing MAG Entm't, LLC v. Div. of Alcoholic Beverage Control, supra, 375 N.J. Super. at 549. A records custodian's obligation under OPRA has been aptly described as follows: "[T]he custodian is obligated to search her files to find the identifiable government records listed in the ... OPRA request .... However, the Custodian is not required to research her files to figure out which records, if any, might be responsive to a broad or unclear OPRA request." Burnett v. Cnty. of Gloucester, 415 N.J. Super. 506, 515 (App. Div. 2010) (quoting Donato v. Twp. of Union, GRC 2005-182, Interim Order (Jan. 31, 2007)). Nothing in OPRA requires a custodian to conduct research among its records and correlate data from various government records in the custodian's possession. Lagerkvist v. Office of the Governor, 440 N.J. Super. 230 (App. Div. 2015). Thus, an agency does not have a duty under OPRA to analyze and evaluate information in order to respond to an OPRA request. Burke v. Brandes, supra, 429 N.J. Super. at 175; Bent v. Twp. of Stafford Police Dep't, supra, 381 N.J. Super. at 40.
For these reasons, I must deny your request.
Because your request for access to a government record has been denied, you have a right to challenge the decision by the Department to deny access. At your option, you may either institute a proceeding in the Superior Court of New Jersey or file a complaint with the Government Records Council ("GRC") by completing the Denial of Access Complaint Form. You may contact the GRC by toll-free telephone at 866-850-0511, by mail at P.O. Box 819, Trenton, NJ, 08625, by e-mail at grc@dca.state.nj.us, or at their web site at www.state.nj.us/grc. The Council can also answer other questions about the law. All questions regarding complaints filed in Superior Court should be directed to the Court Clerk in your County.
If you have any questions concerning this communication, please call me at 609-292-9382.
Sincerely,
Samuel T. Stewart
Regulatory Officer
Office of Legal & Regulatory Compliance
Phone: 609-292-9382
Fax: 609-292-5333
e-mail: samuel.stewart@doh.state.nj.us
From: Anthony Santora
Mr. Stewart:
Please find below a more specific description of the documents being sought:
(1) Spreadsheets, case indexes, reports or summaries maintained and/or used to track or document all complaints of Charity Care fraud, waste and abuse received from 2013 through 2017.
(2) Spreadsheets, case indexes, reports or summaries maintained and/or used to track all complaints of Charity Care fraud, waste and abuse referred to the Office of the State Comptroller, Medicaid Fraud Division from 2013 through 2017.
(3) Spreadsheets, case indexes, reports or summaries maintained and/or used to track or identify the total amount of funds recovered and deposited into the Charity Care fund as a result of a fraud, waste or abuse investigation or audit conducted from 2013 through 2017.
(4) Copies of any policies, procedures, directives, and/or guidelines related to Charity Care fraud, waste or abuse.
Regards,
Anthony Santora
From: Department of Health
Dear Mr. Santora,
* Thank you for the clarification. I made inquiries and have been advised that the Office of the Commissioner does not have any records that are responsive to your request. Responsibility for investigating charity care fraud is vested in the Office of the Medicaid Inspector General. See N.J.S.A. 26:2H-18.60d. You may wish to consider filing your request with the Office of the Medicaid Inspector General. If you have any questions concerning this communication, please call me.
Sincerely,
Samuel T. Stewart
Regulatory Officer
Office of Legal & Regulatory Compliance
Phone: 609-292-9382
Fax: 609-292-5333
e-mail: samuel.stewart@doh.state.nj.us
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