Source: http://newjerseyfraudlawyer.com/types-of-fraudwhite-collar-crimes/new-jersey-medicaid-fraud-lawyer/
Timestamp: 2018-02-22 20:41:51
Document Index: 549807699

Matched Legal Cases: ['§ 17', '§ 2', '§ 16', '§ 16', '§ 2', '§ 3']

New Jersey Medicaid Fraud Lawyer- New Jersey Fraud Lawyer
Home → Types of Fraud/White Collar Crimes → New Jersey Medicaid Fraud Lawyer
Medicaid is a federal and state cost-sharing program that provides health care to people who are unable to pay for such care. Medicaid Fraud almost always targets the providers of services who accept Medicaid and can be prosecuted on the State or Federal jurisdictions.
Our New Jersey Medicaid Fraud Lawyers have found that the Medicaid providers are common targets of Medicaid fraud investigations. Providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies, and any other individual or company that is paid by the Medicaid program.
Examples of provider fraud include, billing for medical services not actually performed, also known as phantom billing; billing for a more expensive service than was actually rendered, also known as upcoding; billing for several services that should be combined into one billing, also known as unbundling; billing twice for the same medical service; billing for sessions that are longer than what was actually performed, a type of upcoding; dispensing generic drugs and billing for brand-name drugs; giving or accepting something in return for medical services, also known as a kickback; bribery; providing unnecessary services; false cost reports; and embezzlement of recipient funds.
As you can see, there are many ways to commit medicaid fraud and many billing errors and other misunderstandings can lead to many providers becoming a target of a medicaid fraud investigation.
New Jersey Medicaid Fraud Penalties/ Referral to the State License Boards
Convictions for Medicaid Fraud can lead to State Prison time and significant penalties.
If a health care provider is convicted of Medicaid Fraud, the New Jersey Attorney General is required to refer the matter to the appropriate professional and occupational licensing board within the Division of Consumer Affairs in the Department of Law and Public Safety or the Director of the Division of Consumer Affairs, as applicable, for such action as they determine appropriate regarding that person’s license or other authorization to practice as a health care professional.
No Presumption of Non-Imprisonment
There is a specific prohibition of the presumption of nonimprisonment set forth in subsection e. of N.J.S.2C:44-1 for persons who have not previously been convicted of an offense.
New Jersey Medicaid Fraud Statute
New Jersey Statutes; Title 30. Institutions and Agencies; Subtitle 1B. Medical Assistance
Chapter 4D. Medical Assistance Program; I. Medical Assistance and Health Services Act; 30:4D-17. Penalties for violation of act; criminal and civil; judgments
(a) Any person who willfully obtains benefits under this act to which he is not entitled or in a greater amount than that to which he is entitled and any provider who willfully receives medical assistance payments to which he is not entitled or in a greater amount than that to which he is entitled is guilty of a crime of the third degree, provided, however, that the presumption of nonimprisonment set forth in subsection e. of N.J.S.2C:44-1 for persons who have not previously been convicted of an offense shall not apply to a person who is convicted under the provisions of this subsection.
with an intent to fraudulently secure benefits or payments not authorized under this act or in a greater amount than that which is authorized under this act; or
(4) Knowingly and willfully converts benefits or payments or any part thereof received for the use and benefit of any provider or any person, firm, partnership, corporation or other entity to a use other than the use and benefit of such provider or such person, firm, partnership, corporation or entity; is guilty of a crime of the third degree, provided, however, that the presumption of nonimprisonment set forth in subsection e. of N.J.S.2C:44-1 for persons who have not previously been convicted of an offense shall not apply to a person who is convicted under the provisions of this subsection.
(d) Whoever knowingly and willfully makes or causes to be made or induces or seeks to induce the making of any false statement or representation of a material fact with respect to the conditions or operations of any institution or facility in order that such institution or facility may qualify either upon initial certification or recertification as a hospital, skilled nursing facility, intermediate care facility, or health agency, thereby entitling them to receive payments under this act, shall be guilty of a crime of the fourth degree.
(e) Any person, firm, corporation, partnership, or other legal entity who violates the provisions of any of the foregoing subsections of this section or any provisions of section 3 of P.L.2007, c. 265 (C.2A:32C-3), shall, in addition to any other penalties provided by law, be liable to civil penalties of (1) payment of interest on the amount of the excess benefits or payments at the maximum legal rate in effect on the date the payment was made to said person, firm, corporation, partnership or other legal entity for the period from the date upon which payment was made to the date upon which repayment is made to the State, (2) payment of an amount not to exceed three-fold the amount of such excess benefits or payments, and (3) payment in the sum of not less than and not more than the civil penalty allowed under the federal False Claims Act (31 U.S.C. s.3729 et seq.), as it may be adjusted for inflation pursuant to the Federal Civil Penalties Inflation Adjustment Act of 1990, Pub.L.101-410 for each excessive claim for assistance, benefits or payments.
(g) All interest and civil penalties provided for in this act and all medical assistance and other benefits to which a person, firm, corporation, partnership, or other legal entity was not entitled shall be recovered in an administrative proceeding held pursuant to the “Administrative Procedure Act,” P.L.1968, c. 410 (C.52:14B-1 et seq.), except that recovery actions against minors or incompetents shall be initiated in a court of competent jurisdiction.
L.1968, c. 413, § 17, eff. Jan. 1, 1970. Amended by L.1976, c. 89, § 2, eff. Sept. 15, 1976; L.1979, c. 365, § 16, eff. Feb. 4, 1980; L.2007, c. 265, § 16, eff. March 13, 2008; L.2010, c. 30, § 2, eff. June 29, 2010.
30:4D-17a. Additional penalties for persons licensed as a health care professional
In addition to any other action authorized or required by law, the Attorney General shall refer any matter regarding a person who is licensed or otherwise authorized to practice a health care profession in this State pursuant to Title 45 or Title 52 of the Revised Statutes and has been convicted of an offense under the provisions of section 17 of P.L.1968, c. 413 (C.30:4D-17), to the appropriate professional and occupational licensing board within the Division of Consumer Affairs in the Department of Law and Public Safety or the Director of the Division of Consumer Affairs, as applicable, for such action as they determine appropriate regarding that person’s license or other authorization to practice as a health care professional.
L.2010, c. 30, § 3, eff. June 29, 2010.
Federal Medicaid Fraud Statute
Federal charges who involve Medicaid Fraud are commonly charged under the general Healthcare Fraud Statute in the United States Code.