Health Care Claims Fraud Lawyer in New Jersey
If you were charged with health care claims fraud in NJ, you should speak with a criminal defense attorney as soon as possible. The penalties under N.J.S.A. 2C:21-4.3 are stiff so you absolutely need the very best representation you can find. The lawyers at Marshall Criminal Defense have exactly what is necessary with:
- 14 attorneys that specialize in criminal defense exclusively
- over 200 years of combined experience defending charges throughout New Jersey
- former county prosecutors that have served as Director of Economic Crimes, Major Crimes, Special Operations, and even an entire Trial Unit
- certified criminal trial attorneys
- history of success representing clients arrested for fraud related offenses
Our firm clearly has substantial experience and a long track record helping people charged with felony economic crimes like health claims fraud. To get in touch with a health care claims fraud lawyer at Marshall Criminal Defense, call (877) 534-7338 or contact us online.
The New Jersey Health Claims Fraud Law
Statistics show that roughly 10% of the overall cost of health insurance in New Jersey, which exceeds 1.0 billion dollars, is attributable to fraud. Lawmakers adopted the Health Care Claim Fraud Act contained at 2C:21-4.2 to discourage fraud committed by medical practitioners, their employees and agents, as well as patients. What the law targets is false or fraudulent claims presented to insurers for payment or reimbursement by both providers or patients.
N.J.S.A. 2C:21-4.2 defines conduct that constitutes New Jersey health claims fraud. The term generally means making a material misstatement or omission of fact in a bill, record, claim or other document or filing intended for consideration in payment or reimbursement for health care services. N.J.S.A. 2C:21-4.3 then goes on to carve out four (4) separate varieties of health care claims fraud that trigger differentiating grades of crime, including a:
- Health care practitioner who knowingly commits fraud during the course of his/her professional services (2C:21-4.3a)
- Health care practitioner who recklessly commits fraud during the course of his/her professional services (2C:21-4.3b)
- Non-practitioner that knowingly commits fraud (2C:21-4.3c)
- Non-practitioner who recklessly commits fraud (2C:21-4.3d)
“Practitioner” is defined as a person licensed or registered to practice medicine, chiropractics, podiatry, dentistry, pharmaceuticals, optometry, nursing, psychiatry/psychology, or physical therapy. “Recklessness” means consciously disregarding a substantial and unjustifiable risk that a fraud may be committed.
Situations Where A Permissive Inference of Fraud Are Created. The health care claims fraud law sets forth instances where a violation of this law may be presumed by a jury. In this regard, fraud is inferred if a practitioner submits a claim for services provided when no such services were actually tendered (i.e. billing for a service that wasn’t provided). An inference is also created if a submission is made for services when it would have been impossible for so many treatments or procedures to be performed during the time frame in question (e.g. 12 one hour sessions submitted when the work day is only 8 hours).
Examples Of Health Care Claims Fraud In New Jersey?
Many acts may be considered health care claims fraud under New Jersey law. The following are just some possible examples:
- Submitting fake invoices
- Sending bills for services or medications not provided
- Certifying that treatment is reasonable and necessary when the related test, procedure, treatment, or other service is not
- Changing medical records
- Intentionally changing a diagnosis to increase the amount to be paid
- Misrepresenting a medical provider’s credentials (including license)
- Billing for services provided by unlicensed employees as though they were licensed
- Forging or altering official forms and applications to distort claims or reimbursements
- Intentionally giving false information when applying for programs or services
- Intentionally enrolling employees or changing treatment dates to capture coverage
Grading of Health Care Claims Fraud
The severity in terms of penalties for health care claims fraud hinges on the state of mind of the actor, as well as whether or not they are a practitioner. An offense can grade as a fourth degree, third degree or second degree crime depending on these factors. The following is a summary of the grading:
Practitioners. It is a second degree crime when a health care practitioner knowingly commits health care claims fraud. It is a third degree crime if the fraud is committed recklessly.
Non-practitioners. It is a third degree crime for a non-practitioner to knowingly commit fraud except where five or more acts of claims fraud or the aggregate loss is $1,000 or more, then it is a second degree crime. Reckless commission of fraud in this context is a fourth degree crime absent five or more acts of fraud or an aggregate loss of $1,000 or more, then it is a third degree crime.
Penalties If Convicted For Health Care Claims Fraud In New Jersey
Second Degree Crime. Knowingly committing health care fraud as a practitioner is, as previously stated, a second-degree crime. A non-practitioner can also be charged in this manner if they knowingly commit 5 or more violations or knowingly commit a violation(s) with an aggregate loss of $1,000 or more. The penalties for second degree health care claims fraud include 5-10 years in prison and a fine of up to $150,000 or five times the benefit derived, whichever is greater.
Third Degree Crime. It is a third degree crime when a practitioner recklessly commits health care fraud and also where a non-practitioner recklessly commits a violation 5 or more times or causes an aggregate loss of $1,000 or more. The penalties for third degree health care claims fraud are up to 5 years in prison and a fine of up to $15,000 or five times the benefit derived from the fraud, whichever is greater.
Fourth Degree Crime. It is a fourth degree crime for a non-practitioner to recklessly commit health care claims fraud under any other circumstance. Fourth degree health care claims fraud triggers up to 18 months in prison and a maximum fine of $15,000 or five times the benefit, whichever is greater.
Suspension of a Medical or Other Health Care License. A medical professional who has been convicted of this crime may be subject to suspension or revocation of their medical license.
NJ Health Care Claims Fraud Attorneys
You absolutely need to treat an accusation of health care claims fraud seriously. You are questionably exposed to potentially dire consequences if convicted of a 2C:21-4.3 offense. There is also the potential for suspension or, worse yet, revocation of your medical license. The most powerful weapon for insuring this does not occur is to hire an attorney that is experienced in this area of law like the team at Marshall Criminal Defense. Our lawyers are skilled in defending insurance fraud charges and are ready to put their knowledge into action so you have the best chance of averting a conviction. Don’t make the mistake of selling yourself short with a lawyer who doesn’t have the attributes for success. Call us now at 855-450-8310 for immediate assist in a free initial consultation.
