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1 N.J.A.R. 240

Medical Assistance, Division of v. Laurel Pharmacy
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Citation: 1 N.J.A.R. 240
Decision Date: 1980
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: The Division of Medical Assistance sought to recover certain prescription payments made to Laurel Pharmacy in its role as a provider under the Medicaid program. Under N.J.A.C. 10:50-1.9, pharmacies are entitled to additional payments in the form of special 'impact increments' if their long- term facility Medicaid and Pharmaceutical Assistance to the Aged program prescriptions exceed certain levels of annual prescription volume. While not disputing that a miscalculation of total prescription volume had resulted in the payment of an incorrect impact increment, Laurel Pharmacy maintained that its prescription volume still qualified it for an impact increment which should be set off against the Division's recoupment claim. The administrative law judge found that since both claims arose out of the same miscalculation of prescription volume and since the Division offered no reason to the contrary, these claims should be considered together in the same proceeding. Accordingly, the judge ordered the calculation of the correct increment due Laurel Pharmacy and that this amount be set off against the original impact increment.
Rule(s) Cited: 10:50-1.9