##### APPENDIX A

Health Care Laws of Particular Concern.

There are numerous federal and State health care laws that are applicable to different aspects of the Practice’s operations. Some of the more relevant health care laws, for which persons and entities found to violate them may be subject to substantial criminal and civil penalties, include the following:

n Anti-Kickback Laws (also referred to as the Medicare and Medicaid Anti-Kickback Statute) – This law prohibits anyone from knowingly and willfully offering, paying, soliciting or receiving anything of value in return for or to induce, recommend or arrange the referral of an individual or the purchase or lease of a product or service covered under Medicare, Medicaid or another governmental health care program. A similar law also applicable to Medicare, Medicaid and other governmental health care programs prohibits anyone from offering or paying anything of value to a patient that the person knows or should know is likely to influence the patient to receive a medical item or service from the person or entity making the offer or payment instead of from another provider.

n False Claims Laws (including the False Claims Act) – These laws prohibit anyone from knowingly presenting or causing to be presented any claim for payment under Medicare, Medicaid or another governmental health care program for a medical item or service that the person knows or should know was not provided as claimed, was false or fraudulent, or was for a pattern of medical items or services that were not medically necessary. Similar laws prohibit false claims made to other third party payors including private insurance companies.

New Jersey False Claims Statutes -- New Jersey Medical Assistance and Health Services Act–(N.J.S. 30:4D-17(a)-(d))

- o criminal penalties for individuals and entities engaging in fraud or other o criminal penalties for individuals and entities engaging in fraud or other criminal violations relating to Title XIX-funded programs. They include: (a) fraudulent receipt of payments or benefits: fine of up to $10,000, imprisonment for up to 3 years, or both; (b) false claims, statements or omissions, or conversion of benefits or payments: fine of up to $10,000, imprisonment for up to 3 years, or both; (c) kickbacks, rebates and bribes: fine of up to $10,000, imprisonment for up to 3 years, or both; and (d) false statements or representations about conditions or operations of an institution or facility to qualify for payments: fine of up to $3,000, or imprisonment for up to 1 year, or both. Criminal prosecutions are generally handled by the Medicaid Fraud Section within the Office of Insurance Fraud Prosecutor, in the N.J. Division of Criminal Justice.

Civil Remedies, N.J.S. 30:4D-7.h., (N.J.S. 30:4D-17(e)-(i); N.J.S. 30:4D-17.1.a.)

- o addition to the criminal sanctions discussed in section 3 above, violations of N.J.S. o addition to the criminal sanctions discussed in section 3 above, violations of N.J.S. 30:4D(a)-(d) can also result in the following civil sanctions: (a) unintentional violations: recovery of overpayments and interest; (b) intentional violation: recovery of overpayments, interest, up to triple damages, and up to $2,000 for each false claim. Recovery actions are generally pursued administratively by the Division of Medical Assistance and Health Services, with the assistance of the Division of Law in the N.J. Attorney General’s Office, and can be obtained against any individual or entity responsible for or receiving the benefit or possession of the incorrect payments.

Health Care Claims Fraud Act ( N.J.S. 2C:21-4.2 & 4.3; N.J.S. 2C:51-5)

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