Health Care Fraud

When we hear the term “health care fraud,” many of us shudder. We think of hospitals, doctors, and patients engaging in terrible activities in order to defraud others. In reality, innocent people get ensnared in health care fraud lawsuits all the time.

Between overzealous prosecutions and attempts to make examples out of doctors or hospital staff members, more people are being charged with committing health care fraud then ever before.

Consequently, it is critical for everyone to know what truly amounts to health care fraud as well as what penalties you could face if convicted of it.

 

What is Health Care Fraud?

According to  N.J.S.A. 2C:21-4.2, health care fraud involves making a false, fictitious, fraudulent or misleading statement of material fact or omitting a material fact from any record, bill, claim, or other document that one submits (or tries to submit) in order to receive payment or reimbursement for health care services.

Depending on whether you are a practitioner or not, there are different degrees of health care fraud.

A “practitioner” is a person who is licensed in New Jersey to practice medicine and surgery, chiropractic, podiatric medicine, dentistry, optometry, psychology, pharmacy, nursing, physical therapy, or law.

Moreover, a “practitioner” can be anyone who is licensed, registered, or certified by a NJ agency to practice a profession or occupation in the State of New Jersey or any person similarly licensed, registered, or certified in another jurisdiction.

 

Penalties for Health Care Fraud | N.J.S.A. 2C:21-4.2

Under N.J.S.A. 2C:21-4.3, if you are a practitioner and knowingly commit health care fraud in the course of providing professional services, then you can be guilty of a second degree crime. This means you could end up serving 5-10 years in jail.

If you are a practitioner and recklessly commit health care fraud in the course of providing professional services, then you can be guilty of a third degree crime. If convicted, you could face 3-5 years in prison.

If you are not a practitioner and knowingly commit health care fraud, you can be guilty of a third degree crime. However, if you knowingly commit 5 or more acts of health care fraud (and the aggregated monetary benefit is at least $1,000), then you can be guilty of a second degree crime.

Furthermore, if you are not a practitioner and recklessly commit health care fraud, you can be guilty of a fourth degree crime. You could go to jail for up to 18 months.

Additionally, the statute specifically provides for an additional punishment for each type of health care fraud.

If you are found guilty of any of the above forms of health care fraud in NJ, you could be compelled to pay a fine of up to 5 times the pecuniary benefit (i.e. monetary amount) you tried to obtain or actually got.

Hire an experienced NJ criminal defense attorney to help you avoid a conviction that can ruin your reputation, put you behind bars, and devastate your financial future.

 

Who Should You Contact?

If you or a loved one has been charged with health care fraud, contact Adam H. Rosenblum of The Rosenblum Law Firm today. His team of New Jersey criminal defense attorneys will do what they can in order to protect your legal rights and fight to keep you out of prison. E-mail or call 888-815-3649 today.