Source: http://newjerseyfraudlawyer.com/types-of-fraudwhite-collar-crimes/new-jersey-health-care-fraud/
Timestamp: 2017-06-29 16:01:24
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New Jersey Health Care Fraud- New Jersey Fraud Lawyer
Home → Types of Fraud/White Collar Crimes → New Jersey Health Care Fraud Health Care Fraud
Healthcare Claims Fraud is a common and diverse crime in New Jersey.
Defendants may include a patient who falsifies or exaggerates an injury or a doctor that is engaging excessive billing, false billing, duplicate billing or a with other New Jersey doctors
Healthcare fraud investigations often start with an entity that is not directly connected to a law enforcement agency such as an insurance company. In fact, some insurance companies employ former police officers that investigate alleged healthcare fraud. This is important for two reasons. First, anything a target or defendant says to these investigators can be used against them. Second, a knowledgeable healthcare fraud attorney may be able to negotiate with the insurance company investigator to reach a civil resolution before it gets to law enforcement. This lag time between investigation and prosecution also allows a healthcare fraud attorney to prepare to defend against a potential prosecution well before any law enforcement agencies are contacted.
New Jersey’s Health Care Fraud Penalties
New Jersey’s Health Care Fraud Statute is found within Title 2C. The New Jersey Code of Criminal Justice; Subtitle 2. Definition of Specific Offenses; Part 2. Offenses Against Property; Chapter 21. Forgery and Fraudulent Practices; 2C:21-4.3. Health care claims fraud; elements; penalties; evidence
As the statute states, Health care fraud may be a second degree crime for practitioners who commit Health care fraud. This means that a defendant can be sentenced up to 10 years in New Jersey State prison. Additionally, a practitioner may be fined up to five times the pecuniary benefit obtained or sought to be obtained.
For patients, Health care fraud usually is a third degree crime which has the possible exposure of 5 years in New Jersey State prison. The crime may a second degree crime if the defendant commits more than five or more acts of health care claims fraud and the aggregate pecuniary benefit obtained or sought to be obtained is at least $1,000. In addition to all other criminal penalties allowed by law, a patient convicted under this subsection may be subject to a fine of up to five times the pecuniary benefit obtained or sought to be obtained.
New Jersey’s Health Care Fraud Statute
2C:21-4.3. Health care claims fraud; elements; penalties; evidence
a. A practitioner is guilty of a crime of the second degree if that person knowingly commits health care claims fraud in the course of providing professional services. In addition to all other criminal penalties allowed by law, a person convicted under this subsection may be subject to a fine of up to five times the pecuniary benefit obtained or sought to be obtained.
(2) The falsity, fictitiousness, fraudulence or misleading nature of a statement may be inferred by the trier of fact in the case of a person who attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted any record, bill, claim or other document for more treatments or procedures than can be performed during the time in which the treatments or procedures were represented to have been performed.
(3) Proof that a practitioner has signed or initialed a record, bill, claim or other document gives rise to an inference that the practitioner has read and reviewed that record, bill, claim or other document.
(2) Nothing in this act shall preclude an assignment judge from dismissing a prosecution of health care claims fraud if the assignment judge determines, pursuant to N.J.S.2C:2-11, the conduct charged to be a de minimis infraction.
L.1997, c. 353, § 3, eff. Jan. 15, 1998. Amended by L.2003, c. 89, § 75, eff. June 9, 2003.
New Jersey Lawyers may also bring De Minimis Infraction motions before the Superior Court Assignment Judge in County where the charges are lodged. Here, the New Jersey Health Care Fraud statute specifically states that “Nothing in this act shall preclude an assignment judge from dismissing a prosecution of health care claims fraud if the assignment judge determines, pursuant to N.J.S.2C:2-11, the conduct charged to be a de minimis infraction.” It is very interesting and important to know that this is specifically included by the New Jersey legislatures.
L.1978, c. 95, § 2C:2-11, eff. Sept. 1, 1979.
Other New Jersey Fraud Statutes
2C:21-4.1. Purposeful destruction, alteration or falsification of record relating to care of medical or surgical or podiatric patient in order to deceive or mislead
L.1989, c. 300, § 15, eff. Jan. 12, 1990.
2C:21-4.2. Definitions relating to health care claims fraud
“Health care claims fraud” means making, or causing to be made, a false, fictitious, fraudulent, or misleading statement of material fact in, or omitting a material fact from, or causing a material fact to be omitted from, any record, bill, claim or other document, in writing, electronically or in any other form, that a person attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted for payment or reimbursement for health care services.
“Practitioner” means a person licensed in this State to practice medicine and surgery, chiropractic, podiatric medicine, dentistry, optometry, psychology, pharmacy, nursing, physical therapy, or law; any other person licensed, registered or certified by any State agency to practice a profession or occupation in the State of New Jersey or any person similarly licensed, registered, or certified in another jurisdiction.
L.1997, c. 353, § 2, eff. Jan. 15, 1998. Amended by L.2005, c. 259, § 20, eff. Jan. 4, 2006.