How New Jersey Health Care Fraud Law Works Against Medical Practitioners

Q. Are Health Care Fraud Crimes prosecuted infraudulent claims. Signing a fraudulent bill or claim
New Jersey as regular theft crimes?alone may serve a proof.
They may be, New Jersey law now has a set ofQ. Does it Matter How Much Money is Stolen?
statutes specifically aimed at health care claimsIt doesn't matter. No matter what the amount of
fraud. The idea is that these crimes have athe claim or benefit is, unless when it is de
broader scope and carry much more severeminimis, New Jersey health care fraud is a second
penalties than regular theft crimes. Also, thedegree crime.
threshold of prove is significantly lower, soQ. What Should the State prove to obtain
prosecutors have much easier time proving theirconviction? To convict a defendant in a New
cases. As of now, New Jersey health care fraudJersey health care fraud case, prosecutors must
is a crime in the second degree that carries up toprove:
10 years imprisonment along with hefty fines. In1. That the defendant was a practitioner;
addition, of course, one may be charged and2. That the defendant made false, fraudulent, or
indicted with any other fraud and theft offensemisleading statement of material fact in, or
besides the health care fraud charge.omitted a material fact from any record, bill, claim
Q. Who is the "medical care practitioner" that mayor other document, in writing, electronically or in
be charged with New Jersey health care fraud?any other from;
According to N.J.S.A. 2C:21-4.2, "practitioner" is3. That the defendant attempted to submit,
anyone licensed in New Jersey or any othersubmitted, caused to be submitted, or attempted
jurisdiction to practice medicine and surgery,to cause to be submitted the record, bill or claim
chiropractic, podiatry, dentistry, optometry,for payment or reimbursement for health care
psychology, pharmacy, nursing, physical therapy,services; and
or law; and any other person licensed, registered4. That the defendant acted knowingly.
or certified by any State agency to practice aQ. What are financial consequences of a
profession or occupation in the State of Newconviction on a defendant?
Jersey.If convicted, the practitioner may be ordered to
Q. What exactly is "health care fraud" in Newpay a fine of up to five times the financial benefit
Jersey?obtained or sought to be obtained. That, of
N.J.S.A. 2C:21-4.2. defines "health care claims fraud"course, doesn't count prison time.
as making, or causing to be made, a false,Q. What if the practitioner committed Health Care
fictitious, fraudulent, or misleading statement ofClaims Fraud without knowledge?
material fact in, or omitting a material fact from,According to N.J.S.A. 2C:21-4.3(b), if the
or causing a material fact to be omitted from,practitioner recklessly commits the health care
any record, bill, claim or other document, incrime without actual knowledge, he or may be
writing, electronically or in any other form, that aguilty of a third-degree crime. The question is
person attempts to submit, submits, causes to bewhat is considered "recklessly". The statute
submitted, or attempts to cause to be submitteddefines that as "conscious disregard of a
for payment or reimbursement for health caresubstantial and unjustifiable risk that the material
services.element exists or will result from his or her
Q. May New Jersey Health Care Fraud beconduct." The state must prove that the risk was
Inferred?such a that the practitioner's disregard of it was a
Yes. As a matter of fact, the statute entitlesgross deviation from the standard of conduct
court to infer in certain cases that medicalthat a reasonable person would observe in the
practitioner committed fraud. That normally has todefendant's situation.
do with making false statements or submitting