| Q. Are Health Care Fraud Crimes prosecuted in | | | | Signing a fraudulent bill or claim alone may |
| New Jersey as regular theft crimes? | | | | serve a proof. |
| | | | |
| They may be, New Jersey law now has a set of | | | | Q. Does it Matter How Much Money is Stolen? |
| statutes specifically aimed at health care | | | | |
| claims fraud. The idea is that these crimes | | | | It doesn't matter. No matter what the amount |
| have a broader scope and carry much more | | | | of the claim or benefit is, unless when it is |
| severe penalties than regular theft crimes. | | | | de minimis, New Jersey health care fraud is a |
| Also, the threshold of prove is significantly | | | | second degree crime. |
| lower, so prosecutors have much easier time | | | | |
| proving their cases. As of now, New Jersey | | | | Q. What Should the State prove to obtain |
| health care fraud is a crime in the second | | | | conviction? To convict a defendant in a New |
| degree that carries up to 10 years | | | | Jersey health care fraud case, prosecutors |
| imprisonment along with hefty fines. In | | | | must prove: |
| addition, of course, one may be charged and | | | | |
| indicted with any other fraud and theft | | | | 1. That the defendant was a practitioner; |
| offense besides the health care fraud charge. | | | | |
| | | | 2. That the defendant made false, fraudulent, |
| Q. Who is the "medical care practitioner" | | | | or misleading statement of material fact in, |
| that may be charged with New Jersey health | | | | or omitted a material fact from any record, |
| care fraud? | | | | bill, claim or other document, in writing, |
| | | | electronically or in any other from; |
| According to N.J.S.A. 2C:21-4.2, | | | | |
| "practitioner" is anyone licensed in New | | | | 3. That the defendant attempted to submit, |
| Jersey or any other jurisdiction to practice | | | | submitted, caused to be submitted, or |
| medicine and surgery, chiropractic, podiatry, | | | | attempted to cause to be submitted the |
| dentistry, optometry, psychology, pharmacy, | | | | record, bill or claim for payment or |
| nursing, physical therapy, or law; and any | | | | reimbursement for health care services; and |
| other person licensed, registered or | | | | |
| certified by any State agency to practice a | | | | 4. That the defendant acted knowingly. |
| profession or occupation in the State of New | | | | |
| Jersey. | | | | Q. What are financial consequences of a |
| | | | conviction on a defendant? |
| Q. What exactly is "health care fraud" in New | | | | |
| Jersey? | | | | If convicted, the practitioner may be ordered |
| | | | to pay a fine of up to five times the |
| N.J.S.A. 2C:21-4.2. defines "health care | | | | financial benefit obtained or sought to be |
| claims fraud" as making, or causing to be | | | | obtained. That, of course, doesn't count |
| made, a false, fictitious, fraudulent, or | | | | prison time. |
| misleading statement of material fact in, or | | | | |
| omitting a material fact from, or causing a | | | | Q. What if the practitioner committed Health |
| material fact to be omitted from, any record, | | | | Care Claims Fraud without knowledge? |
| bill, claim or other document, in writing, | | | | |
| electronically or in any other form, that a | | | | According to N.J.S.A. 2C:21-4.3(b), if the |
| person attempts to submit, submits, causes to | | | | practitioner recklessly commits the health |
| be submitted, or attempts to cause to be | | | | care crime without actual knowledge, he or |
| submitted for payment or reimbursement for | | | | may be guilty of a third-degree crime. The |
| health care services. | | | | question is what is considered "recklessly". |
| | | | The statute defines that as "conscious |
| Q. May New Jersey Health Care Fraud be | | | | disregard of a substantial and unjustifiable |
| Inferred? | | | | risk that the material element exists or will |
| | | | result from his or her conduct." The state |
| Yes. As a matter of fact, the statute | | | | must prove that the risk was such a that the |
| entitles court to infer in certain cases that | | | | practitioner's disregard of it was a gross |
| medical practitioner committed fraud. That | | | | deviation from the standard of conduct that a |
| normally has to do with making false | | | | reasonable person would observe in the |
| statements or submitting fraudulent claims. | | | | defendant's situation. |