How New Jersey Health Care Fraud Law Works Against Medical Practitioners

Q. Are Health Care Fraud Crimes prosecuted in New Jersey as regular theft crimes? They may be, New Jersey law now has a set of statutes specifically aimed at health care claims fraud. The idea is that these crimes have a broader scope and carry much more severe penalties than regular theft crimes.

Also, the threshold of prove is significantly lower, so prosecutors have much easier time proving their cases. As of now, New Jersey health care fraud is a crime in the second degree that carries up to 10 years imprisonment along with hefty fines. In addition, of course, one may be charged and indicted with any other fraud and theft offense besides the health care fraud charge. Q. Who is the "medical care practitioner" that may be charged with New Jersey health care fraud? According to N.J.

S.A. 2C:21-4.

2, "practitioner" is anyone licensed in New Jersey or any other jurisdiction to practice medicine and surgery, chiropractic, podiatry, dentistry, optometry, psychology, pharmacy, nursing, physical therapy, or law; and any other person licensed, registered or certified by any State agency to practice a profession or occupation in the State of New Jersey. Q. What exactly is "health care fraud" in New Jersey? N.J.

S.A. 2C:21-4.2. defines "health care claims fraud" as making, or causing to be made, a false, fictitious, fraudulent, or misleading statement of material fact in, or omitting a material fact from, or causing a material fact to be omitted from, any record, bill, claim or other document, in writing, electronically or in any other form, that a person attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted for payment or reimbursement for health care services. Q.

May New Jersey Health Care Fraud be Inferred? Yes. As a matter of fact, the statute entitles court to infer in certain cases that medical practitioner committed fraud. That normally has to do with making false statements or submitting fraudulent claims. Signing a fraudulent bill or claim alone may serve a proof. Q.

Does it Matter How Much Money is Stolen? It doesn't matter. No matter what the amount of the claim or benefit is, unless when it is de minimis, New Jersey health care fraud is a second degree crime. Q. What Should the State prove to obtain conviction? To convict a defendant in a New Jersey health care fraud case, prosecutors must prove: 1. That the defendant was a practitioner; 2. That the defendant made false, fraudulent, or misleading statement of material fact in, or omitted a material fact from any record, bill, claim or other document, in writing, electronically or in any other from; 3.

That the defendant attempted to submit, submitted, caused to be submitted, or attempted to cause to be submitted the record, bill or claim for payment or reimbursement for health care services; and 4. That the defendant acted knowingly. Q. What are financial consequences of a conviction on a defendant? If convicted, the practitioner may be ordered to pay a fine of up to five times the financial benefit obtained or sought to be obtained. That, of course, doesn't count prison time. Q.

What if the practitioner committed Health Care Claims Fraud without knowledge? According to N.J.S.A. 2C:21-4.3(b), if the practitioner recklessly commits the health care crime without actual knowledge, he or may be guilty of a third-degree crime.

The question is what is considered "recklessly". The statute defines that as "conscious disregard of a substantial and unjustifiable risk that the material element exists or will result from his or her conduct." The state must prove that the risk was such a that the practitioner's disregard of it was a gross deviation from the standard of conduct that a reasonable person would observe in the defendant's situation.

Joseph Potashnik is a criminal defense lawyer practicing in New Jersey and New York City. He regularly defends clients accused of various types of offenses including fraud and white-collar crimes. You can learn more about New Jersey health care fraud and how a consultation with an experienced criminal lawyer can benefit by visiting Mr. Potashnik's websites at for NJ and for NY.

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