New Jersey Healthcare Attorneys
In such an industry as heavily regulated as the healthcare industry, physicians, practitioners, administrators, therapists and staff can easily encounter situations in which they need to consult with an experienced health care attorney.
With experience in all aspects of health care law, our attorneys represent client interests in a wide array of regulatory, litigation counseling, employment and criminal related matters. Our attorneys have helped clients resolve some of the most complex legal issues including corporate structure, merger and acquisitions, government regulations and state and federal fraud abuse matters. Whether you need to speak to an attorney about complex contract negotiations, corporate transactions or about representation in complex litigations or potential criminal proceedings, the attorneys at the Health Law Group can help.
Our New Jersey law office helps healthcare providers including hospitals, physicians, treatment centers, clinics, dental offices and more. We understand the unique challenges that pharmaceutical manufacturers and durable medical equipment manufacturers face. Our healthcare lawyers can help with matters related to but not limited to:
Help providers with internal audits and investigations to ensure system wide compliance.
Assist providers with proactive strategies to potential legal issues
Represent providers when partners of contracting parties do not meet their contractual responsibilities
Represent individual practitioners and executives in criminal matters that may arise out of their professional responsibility.
As a healthcare provider in New Jersey, there are various ways that you can be accused of healthcare fraud. Please contact our office to speak with one of our attorneys and to get a free review of your case.
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Statutes And Penalties That Apply To Healthcare Fraud In New Jersey
New Jersey Statutes
New Jersey Healthcare Claims Fraud § 2C:21-4.2 (definitions) § 2C:21-4.3.
In New Jersey, you are prohibited from submitting any false claims to an insurance company for the purpose of getting paid for healthcare services when you did not actually provide those services. If you do such an act, you have committed a crime.
In the event that you are charged with §2C:21-4.3 you will be subject to the New Jersey criminal sentencing guidelines. This means your penalties will depend on the severity of the crime.
Penalty For Third Degree: Under the healthcare claims fraud statute they will be subject to up to five times the amount received or attempted to be received. Additionally, for being found guilty of a third degree crime in New Jersey, you are subject to a state prison sentence ranging from 3 to 5 years and a criminal fine of up to $15,000.
Second Degree: When a healthcare provider is found to have knowingly committed healthcare claims fraud while they were providing healthcare services. They will be subject to a fine that is calculated by multiplying the benefit received or attempted to be received by five.
Penalty For Second Degree: When you are found guilty of a second degree crime in New Jersey you will be subject to a sentence of 5 to 10 years in the New Jersey state prison and you will be fined up to $150,000.
New Jersey Medicaid Fraud NJSA 30:4D-17
New Jersey also makes it illegal to accept an offer, receive, or participate in a scheme for the purpose of kickbacks in exchange with providing services or items that are billed to Medicaid.
This statute also makes it illegal to bill for more than the actual cost of the services you provided.
Finally, this statute makes it illegal to receive more benefits than you are entitled to.
The penalties for being found guilty of violating NJSA 30:4D-167 are a prison term of up to 3 years and a penalty in the amount of $10,000.
Anti-Kickback 42 U.S.C. 1320a-7b(b)
Being a healthcare provider in New Jersey means that the business deals that you make in relation to your healthcare professionals are regulated. Under the anti-kickback statute, referrals that are made in exchange for services or goods are limited to those people with whom you have no close family ties or financial relationship. This applies to both making or receiving referrals.
In order to prove that you have violated the anti-kickback statute in your role as a New Jersey healthcare provider, your accuser must show that you purposefully engaged in activities surrounding the exchanged of referrals for money or goods (meaning equipment).
Penalties For Anti-Kickback
Being charged with anti-kickback in New Jersey subjects you to certain federal penalties. These penalties include up to 5 years in federal prison and a fine of up to $25,000.
Healthcare Fraud 18 U.S.C. § 1347
When you are accused of healthcare fraud, certain things need to be proven. These things include that you purposely attempted to defraud a healthcare benefits program, with the purpose of receiving a benefit from that healthcare benefits program. You do not have to have specific intent to commit this crime.
Penalties For Healthcare Fraud
If you are accused or found guilty of committing healthcare fraud as a New Jersey healthcare practitioner you will be subject to a range of penalties. Generally, they will be assessed based on the facts specific to your case.
You may have to pay a fine or serve a prison term. In many instances, both the fine and prison term can be ordered. Generally, this prison term will be up to ten years. The prison term could be raised to up to 20 years in the event that the healthcare you provide, where you are also alleged to be committing fraud, causes serious bodily injury or death of one of your patients.
False statements relating to healthcare matters 18 U.S.C. § 1035
This statute looks your statements when diagnosing, filling out charts, filling out prescriptions, and even submitting claims for reimbursement for services. Any fraudulent entries that you make can cause a violation of this statute.
Penalties For False statements relating to healthcare matters 18 U.S.C. § 1035
If you are accused or found guilty of making false statements, you could face criminal penalties that could include both fines and terms of imprisonment.
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As a healthcare provider in New Jersey, you are subject to both criminal and civil lawsuits and penalties for your actions as a provider.
Similar to the criminal healthcare fraud statute, you could be sued in New Jersey on a state and federal level. The reason for this suit would be based on allegations that within your healthcare practice and the services that you provide, you made claims for services that you did not provide or services that were unnecessary.
Penalties For Violating The False Claims Act
When you are accused of violating the false claims act, you can face both fines, refunds, and restitution.
The fine itself can vary. Each action that is alleged to violate the false claims act comes with a potential fine ranging from $5,000 to $10,000.
Refunds are a form of damages. Essentially if your New Jersey healthcare practice received any benefits from any of the various healthcare benefits programs, you will have to refund those benefits.
Restitution will come into play if it is found that patients had to pay any kind of unnecessary fee for your alleged violation of the False Claims Act. Essentially, this means you will pay the patient back for the damages you caused them.
Physician Self-Referral / Stark Law – 42 U.S.C. 1395nn
In addition to the Anti-Kickback Statute, you can also be civilly sued for the referrals that you make in relation your healthcare services. The civil statute is called the Physician Self-Referral law but is better known as the Stark law. The statute prohibits you from referring patients in situations where the person to whom they are being referred is a close family member or you have a financial relationship.
Depending on the specific allegations against you, penalties from the Stark Law will vary and there are four sanctions available: 1) Refunds, 2) payment denial, 3) fines, and 4) fine for aiding with false claims.
Defenses For New Jersey Healthcare Fraud Accusations
Whether you are facing criminal charges or a civil lawsuit, to fight the case you will need a defense. Having a defense is the way to justify your actions, show that you did not violate any statutes, or cast doubt.
Generally, there is no specific defense. This is because every case is different. We do not get to pick the facts of cases. Instead, we apply them as they happened. Depending on the facts of your case, we will focus on the things that show the allegations are untrue.
Defenses can come in the form of your state of mind, a mistake of fact, or a general mistake in your practices. The strongest defense is the one that is most convincing and that attacks the elements required to prove you are in violation of a statute.
Coming up with a defense is not always easy. Generally, you need to work with your defense attorney to give your side of the story. An experienced defense attorney will comb through the facts of your case to find the best defense and see how it can best be used in your case.
What To Do If You Are Accused of Healthcare Fraud In New Jersey
Being charged with a federal or state crime relating to healthcare fraud is a serious situation. The same goes for being civilly sued. This is because both civil and criminal actions can be brought against you. Even if the two cases do not happen at the same time, they will likely affect the other.
Because of the various penalties that come with even just an accusation, such as losing your job, you should be taking steps to avoid any suspicions or allegations against you. Mistakes can be made and allegations of healthcare fraud can be the result. Figure out why you are being accused. Discontinue that practice. Do not talk to anyone unless it is your attorney.
Contact our law office to be put into contact with our highly experienced team of healthcare fraud attorneys today.
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New Jersey Healthcare Fraud In The News
New Jersey Doctor Involved In Undercover Operation Charged With Healthcare Claims Fraud.
In 2018, a Hudson doctor was charged with multiple counts including 16 counts of healthcare claims fraud itself.
Part of the case included the attorney general sending undercover officers who posed as patients to the Hudson doctor’s New Jersey practice. In this position, they were referred to the Hudson doctor’s practice by runners illegally employed by the same doctor.
When these undercover officers met with the doctor, they expressed they were not feeling any pain. The doctor ignored their comments and still recommended physical therapy even though it was clearly not necessary.
It is further alleged that the Hudson doctor was not only recommending physical therapy as treatment, he was also providing the physical therapy. This service included massages, exercises, and electric stimulation. Once the Hudson doctor was done providing these unnecessary treatments, he billed private insurance companies.
As part of their investigation, the officers made sure that they conducted their undercover surveillance thoroughly. This included wearing wires and body cameras catching a lot of the misconduct as evidence.
In addition to the allegations of unnecessary services, the New Jersey attorney general also accused the Hudson doctor of billing private insurers for services that were not actually performed.
Each count of second degree healthcare fraud comes with a prison sentence that ranges from 5 to 10 years and a fine of up to $150,000. If the Hudson doctor is found guilty of these allegations, he can face 80-160 years in prison and $2.4 million in fines.
Home Health providers Indicted, Allegations Say They Were Claiming To Provide Care When They Really Were Not.
An in home healthcare provider, Confident Care Corporation, has multiple healthcare providers who have been indicted or investigated for healthcare fraud. In 2014, three employees were separately indicted for their alleged acts that resulted in fraud and theft.
The first individual was charged with 45 counts of healthcare fraud in the second degree. Part of the allegations included submitting false claims for services to the Medicaid program.
The New Jersey attorney general alleges that these claims were false because at the time of the services the provider was either out of the country or was on another unrelated job. From these false claims, the amount paid to the provider was $64,125.
A second healthcare provider was indicted on 24 counts of healthcare fraud.
It is alleged that during a period of about one year, this healthcare provider submitted 212 claims to the Medicaid program that were falsified. They were falsified because no services were ever performed.
The New Jersey Attorney General intends to prove that these services were not actually provided by showing that this healthcare provider was also out of the country. The alleged amount that the Medicaid program paid to the provider is $6,664.
The third employee involved was also indicted for healthcare fraud on 45 different counts. The evidence supports that over a four year period this provider made claims of providing services when he did not.
The facts support this employee was also out of the country during the time of services. It is further alleged that the money he received was in the amount of $2,180.
Also noteworthy, during these investigations, the New Jersey Attorney General found that there were two other individuals who were no longer employed at Confident Care Corporation who were previously charged for similar allegations. Therefore showing a pattern of abuse and fraud.
Two Operators At A Medical Supply Store In New Jersey Plead Guilty Healthcare Claims Fraud For False Billing
In 2013, two individuals who provided products to healthcare providers pleaded guilty for their scheme to commit Medicaid fraud in New Jersey.
The damages for these violations amounted to a minimum of $150,000.
Upon finding out that fraud could be occurring at DND Medical LLC, the attorney general and the insurance fraud prosecutor conducted an undercover investigation. During this investigation, it was found that these two individuals were selling shoes from their medical supply store. Some of these shoes were covered by the Medicaid program.
These two individuals were selling orthopedic shoes and claiming they fell under the Medicaid program. In reality, these shoes were not actually orthopedic and not covered by the Medicaid program. Nonetheless, these two individuals still submitted the claims.
The scheme was implemented for a period of 5 years from 2006 to 2011. The two were charged with multiple healthcare fraud related charges including second-degree healthcare claims fraud and second-degree conspiracy.
As part of the plea agreement, these individuals have agreed to be suspended from participating in Medicaid program options for a period of eight years.
Middlesex County Woman Pleads Guilty to Healthcare Claims Fraud
In 2012 a New Jersey healthcare provider pleaded guilty to second-degree healthcare claims fraud.
By pleading guilty, this New Jersey healthcare provider admitted that she committed healthcare fraud by submitting false prescriptions to pharmacies, even though she knew that the receipt from any benefits from these prescriptions was fraudulent.
In addition, the investigation into this healthcare fraud scheme showed that the pharmacies also received a benefit from the insurance companies reimbursement that totaled $17,471. It turned out that when this healthcare provider was writing these prescriptions, the patients had no actual knowledge that the prescriptions were being written for them.
As part of the guilty plea that was entered between the healthcare provider and the state of New Jersey, the Attorney General has agreed to make a sentencing recommendation to the court for five years of special probation where she will be supervised by the Drug Court Program in Union County, NJ.
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New Jersey Teacher Charged With Healthcare Fraud Conspiracy Targeting New Jersey School Employees Health Benefits Program
In late 2018, a public school teacher in New Jersey was federally charged with healthcare fraud in relation to prescription medications.
The allegations against the public school teacher included that she bribed three other teachers to defraud the New Jersey School Employees Health Benefits Program.
The scheme they were involved in included being paid $500 to obtain certain types of medications that were not needed. Based on this fraudulent scheme, the New Jersey School Employees Health Benefits Program paid more than $550,000.
New Jersey Guidance Counselor Admits Healthcare Fraud Conspiracy Targeting State Health Benefits Programs
In early 2018, the 13th defendant in a large healthcare fraud scheme pleaded guilty. This New Jersey educator was a member of a larger conspiracy that included doctors, recruiters, and state and local government employees.
Essentially, the goal was to use their state benefit plans to make money off of insurance reimbursements in relation to unnecessary prescriptions. The charging documents in this case alleged that the educator had a practice of getting examinations to be prescribed medications that he did not need. He would then use private and personal information of other patients to provide to doctors to obtain prescriptions illegally. These things were done in exchange for direct payment for each prescription filled.
As earlier mentioned, this case included a number of individuals. One of the people involved was a pharmaceutical representative. This pharmaceutical representative would go to doctors and bribe them to sign off on the prescriptions.
As a result of entering into a guilty plea, the New Jersey educator agreed to forfeit $392,684.20 This was the amount that he received. Additionally, he must pay restitution which will cost him a minimum of $3,493,170.18.