Have you been charged with insurance fraud or health care claims fraud in New Jersey? Charges for insurance and health care fraud can be based on any number of actions, such as submitting a false claim, omitting material facts in an insurance application, or giving false information to an insurance adjuster. Whatever your circumstances, insurance fraud charges are very serious and can result in hefty fines and jail sentences.
Charged with Insurance Fraud or Health Care Fraud in NJ?
My name is Anthony N. Palumbo, and if you've been charged with insurance fraud in New Jersey, I can help. As a New Jersey Insurance and Health Care Fraud Charges Lawyer and partner at the law firm of Palumbo & Renaud, I have more than 35 years of experience and I know how to argue the defenses necessary to win your case. For a free and confidential consultation with a fraud defense attorney, contact me today through the email form on my website or call me at 1-866-664-8118.
What is Insurance Fraud?
Insurance fraud occurs when a person submits a false claim to an insurance company or submits a claim that misleadingly omits material information. Insurance fraud also includes other types of insurance scams like submitting false or misleading claims in an application to obtain or renew an insurance policy, or making fraudulent statements in other documents such as payments, affidavits, or certifications. It's important to understand that insurance fraud includes both making false statements and misleadingly omitting material facts, and it includes both written and oral statements. The Insurance Law is codified in sections 2C:21-4.4 through 2C:21-4.6 of the New Jersey Code of Criminal Justice and can be accessed here. It covers various types of insurance fraud, including auto insurance fraud and life insurance fraud.
Significantly, the New Jersey Insurance Law specifies that each fraudulent statement or omission counts as a separate and distinct crime. This means that a single document can result in multiple counts of insurance fraud if it contains more than one fraudulent statement or omission.
Insurance Fraud Penalties
Insurance fraud is generally a third degree crime, punishable by 3 to 5 years in prison. However, the offense is upgraded to second degree insurance fraud and is punishable by 5 to 10 years in prison if a person knowingly commits 5 or more acts of insurance fraud (including health care claims fraud, which is discussed below), and the aggregate value of the benefit that was wrongfully sought or received was at least $1,000.
What is Health Care Claims Fraud?
Under the New Jersey Health Care Claims Fraud Law, it's illegal for a person to submit a false claim to an insurance company in order to be paid for health care services that were not actually received or provided, or to receive treatment for nonexistent injuries, or to otherwise submit a fraudulent claim in order to cheat a health care insurance provider. Health care insurance fraud includes both making false statements and misleadingly omitting material facts from health care documents.
As with insurance fraud, each fraudulent statement or omission counts as a separate and distinct crime, so a single health care document can result in multiple counts of health insurance fraud if it contains more than one false statement or fraudulent omission.
Who can commit Health Care Claims Fraud?
Medical insurance fraud can be committed either by practitioners-meaning doctors, nurses, dentists, physical therapists, and other licensed health care workers-or by non-practitioners, such as patients and health care employees. The distinction is an important one for determining the penalties that will result from a health care fraud offense.
Penalties for Health Care Claims Fraud
If a practitioner knowingly commits health care claims fraud during the course of providing professional services, it's a second degree crime punishable by 5 to 10 years in prison, and if a practitioner recklessly commits health care claims fraud during the course of providing professional services, it's a third degree crime punishable by 3 to 5 years in prison.
If a non-practitioner knowingly commits health care claims fraud, it's a third degree crime punishable by 3 to 5 years in prison, except that it becomes a second degree crime, punishable by 5 to 10 years in prison, if the non-practitioner knowingly commits 5 or more acts of health care claims fraud and the aggregate pecuniary benefit sought or obtained is at least $1,000. If a non-practitioner recklessly commits health care claims fraud, it's a fourth degree crime, which is punishable by up to 18 months in prison.
In addition to these penalties, a person who has been convicted for health care claims fraud can also be fined up to 5 times the pecuniary benefit that he sought or obtained through his fraudulent actions.
A person who has been charged with health care claims fraud may also be charged with Medicaid fraud. Under section 30:4D-17 of the New Jersey Statutes, it's a third degree crime, punishable by 3 to 5 years in prison, for a person to over-bill Medicaid for services provided, to receive more Medicaid benefits than he's entitled to, or to participate in a scheme to offer or receive kickbacks in connection with the furnishing of items or services that are billable to Medicaid.
Fraudulent Motor Vehicle Insurance ID Cards
In addition to these insurance fraud offenses, it's also illegal under section 2C:21-2.3 of the New Jersey Code of Criminal Justice to falsify a motor vehicle insurance identification card. Producing or selling fake vehicle insurance cards is a third degree offense, subject to 3 to 5 years in prison, while displaying a fake vehicle insurance card to a police officer is a fourth degree offense, punishable by up to 18 months in prison. Simply possessing a fake insurance card is a disorderly persons offense, which carries a penalty of up to 6 months imprisonment.
Getting the Defense You Deserve
If you've been charged with insurance fraud in New Jersey, having an experienced insurance defense lawyer on your side is essential. If you need a criminal defense lawyer, contact me today through the email form on my website or call me at 1-866-664-8118 for a free and confidential consultation. As a former prosecutor and current criminal defense lawyer with over 35 years of experience, I'm familiar with both sides of the law and I've obtained hundreds of dismissals and downgraded charges for criminal defendants. While each case is unique, I can review your case and give you an honest assessment of the penalties you're facing and the best possible defenses that can be raised on your behalf.
Anthony Palumbo is a New Jersey criminal defense lawyer with offices in Cranford, Elizabeth and Newark. We provide criminal defense services for many other types of charges, including white collar crimes such as forgery, identity theft/credit card fraud, and computer crimes.