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New Jersey Consumer Fraud

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In fact, New Jersey has the toughest criminal insurance fraud statutes in the country. The Health Care Claims Fraud statute, N.J.S.A. 21-4.3 and the Insurance Fraud statute, N.J.S.A. 2C:21-4.6, make many acts of insurance fraud second-degree crimes. For starters, a second-degree crime in New Jersey carries with it a prison term of up to ten years and fines of up to $150,000.

The vast majority of insurance fraud cases in New Jersey are investigated and prosecuted by the Office of Insurance Fraud Prosecutor (OIFP) and these cases involve all thinkable areas of insurance fraud, including health, life, disability, auto, homeowners' or commercial insurance coverages.

According the 2007 OIFP report, there was "a 10% increase in criminal sentences over last year's figure and sent defendants to prison for a combined total of 147 years". The report exemplifies the wide array of individuals who found themselves in trouble for insurance fraud: " In 2007, OIFP recorded OIFP won convictions of four former police officers, two of whom will serve a total of 12 years in State prison. Four licensed health care providers received State prison sentences totaling 12 years. A licensed insurance agent was sentenced to a five-year State prison term. An auto body shop owner and his accomplice were sent to State prison for a total of nine years. The sentences imposed on several members of vehicle theft rings totaled 77 years in State prison, over $1.8 million in restitution, and $9,500 in civil insurance fraud fines". The list goes on.

So, what is "insurance fraud" made of? One large area of Insurance fraud in New Jersey is Automobile Insurance Fraud. The most popular crime here is auto theft and "give up schemes", where the owner or lessee of a car abandons the car or gives it up to a someone who agrees to dispose of the car. Next come staged accidents and fraudulent Personal Injury Protection Claims and criminal use of "runners". These types of cases normally involve organized rings of "runners", medical providers, and lawyers. Vehicle Insurance policies in New Jersey provide medical benefits for persons injured in car accidents as part of Personal Injury Protection (PIP) coverage. PIP insurance typically covers diagnostic testing and treatment for persons injured in automobile accidents. In many cases, uninjured passengers involved in accidents are contacted by "runners" who convince them to file claims for "soft tissue" injuries, such as "whiplash". Such injuries are not easily verifiable by x-rays and MRI. In the end, "runners" receive their illegal commissions, medical and chiropractic mills provide unnecessary medical services, including fake diagnostic and treatment, for which they bill, and lawyers file unwarranted lawsuits.

Other case involving New Jersey Automobile Insurance Fraud are selling and buying fake insurance ID cards and insurance agent fraud where licensed agents steal insurance premiums or are engaged in fraudulent premium financing schemes.

Another large area that pays bills for New Jersey insurance fraud criminal defense attorneys is Health Care insurance fraud. Most such cases involve submitting fraudulent claims for payment for health care services that were never provided and received. The most often targeted individuals here are New Jersey doctors, dentists, chiropractors, nurses, physical therapists, pharmacists, and social workers. The most widely used tool in New Jersey heal care insurance fraud prosecutions is the Health Care Claims Fraud status, N.J.S.A. 2C:21-4.3 that makes it a crime for any health care provider just to submit a false claim to insurance companies, no matter what the amount is. A non-provider only needs to submit a false claim for $1,000 to have committed a second-degree crime. Other criminal charges used in prosecutions of New Jersey health care insurance fraud cases are usually charges of theft, conspiracy, and falsifying records.

Another area of New Jersey insurance fraud is life and disability insurance fraud, both governed by the Insurance Fraud Statute, N.J.S.A. 2C:21-4.6. Life insurance fraud offense is submitting a claim that falsely represents death of a claimant or otherwise misrepresenting important facts concerning the claim. Disability fraud involves faking a non-existing condition in order to receive benefits or knowingly failing to disclose new income.

Probably the largest single area of New Jersey Insurance Fraud is Medicaid fraud, which is investigated and prosecuted by the OIFP's Medicaid Fraud Section. New Jersey Medicaid Fraud can be committed by any health care provider that participates in the Medicaid program. New Jersey physicians, dentists, clinics, chiropractors, pharmacists, laboratories, nursing homes, etc. are routinely prosecuted for New Jersey Medicaid fraud.

The basic New Jersey Medicaid fraud crime involves billing the Medicaid program for services that were never provided or might not be provided by the billing provider, or when the amount billed exceeds the costs of services performed (over billing). Other Medicaid fraud charges in New Jersey may be associated with charges of patient abuse and criminal neglect.

Another related New Jersey Medicaid fraud area is Medicaid prescription and drug diversion fraud. This involves pharmacies billing Medicaid for drugs that were not actually dispensed. Doctors, who sometimes form "partnerships" with pharmacies to engage in this fraud, are understandably find themselves in deep trouble as well.

Home health care fraud is the last largely prosecuted New Jersey Medicaid fraud crime. Medicaid pays for personal care provided for eligible beneficiaries by certified home care assistants, aides, and nurses, all of whom must be certified and licensed by the State to participate in the program. Criminal activities in this are involve billing for services that were not provided, employing non-certified providers, and lying in the certification process.

New Jersey insurance fraud is a wide area and persons facing any of the insurance fraud charges should seek legal counsel as soon as they discover that they are under investigation. A consultation with a competent New Jersey fraud defense attorney is absolutely indispensable.

New Jersey Consumer Fraud

According to N.J.S.A. 2C: 51-5A, a New Jersey health care practitioner such as a doctor, who is convicted of a second degree health care claims fraud crime or a similar crime, will permanently forfeit his or her license and will never be able to practice the profession. The only way to prevent that is for the defense to argue that such license forfeiture would be a serious injustice, which overrides the need to deter such conduct by others. The court may consider another period of license suspension, but no less than one year. If you are lucky and the court does not permanently forfeit your license right away, the sentence is not final for 10 days so that the prosecution may appeal it.

When a practitioner is convicted of third degree health care claims fraud or a similar crime for the first time, there will be mandatory license suspension for at least one year. The second conviction will cost you your license for good.

Q. How will the licensing agency be notified of forfeiture or suspension?

A court will enter an order of license forfeiture or suspension immediately after a plea of guilty or finding the defendant guilty, assuming any of this happens in New Jersey. The order is effective as of the date of conviction r guilty plea. If it is an out of state or a federal conviction, or the defendant forfeited his license in another state, the court will enter the forfeiture order upon application of the county prosecutor or the Attorney General.

Q. May a license forfeiture order be stayed while the case is pending appeal?

An order of license forfeiture or suspension will usually not be stayed pending appeal of a conviction or forfeiture or suspension order unless the appellant's attorney convince the court that there is a substantial likelihood of success on the merits. If the appeal is successful and the conviction is reversed or the order of license forfeiture or suspension is overturned, the court will notify the licensing agency within 10 days of the date of the order of reinstatement. That does not guarantee that the license will be restored because the agency, such as the New Jersey Board of Medical Examiners, may decide to suspend or revoke the license on its own motion.

Q. May a professional license be forfeited or suspended by a licensing agency?

Absolutely! This can be done by special application by the Attorney General. The situation may arise in a case where the issue of license forfeiture or suspension is not even discussed raised in a court when the practitioner pleads guilty or is found guilty. However, the fact that a court has not ordered license forfeiture or suspension does not stop the licensing agency from doing that on its own accord. The decision may be based on the argument that the conduct giving rise to the conviction demonstrates that the person is unfit to hold the license or is otherwise liable for an offense.

Q. Can a professional or medical license be reinstated in New Jersey?

N.J.S.A. 2C:52-27.1(a) provides the procedure for reinstatement of forfeited professional licenses. If the conviction record is expunged, the convicted practitioner who lost his or her license as the result of conviction may ask the court for an order to rescind the court's order of forfeiture if the person can demonstrate that he or she is sufficiently rehabilitated. If an order to rescind the court's order of debarment is granted, the next step is to apply to the licensing agency for license reinstatement.

According to N.J.S.A. 2C: 51-5A, a New Jersey health care practitioner such as a doctor, who is convicted of a second degree health care claims fraud crime or a similar crime, will permanently forfeit his or her license and will never be able to practice the profession. The only way to prevent that is for the defense to argue that such license forfeiture would be a serious injustice, which overrides the need to deter such conduct by others. The court may consider another period of license suspension, but no less than one year. If you are lucky and the court does not permanently forfeit your license right away, the sentence is not final for 10 days so that the prosecution may appeal it.

When a practitioner is convicted of third degree health care claims fraud or a similar crime for the first time, there will be mandatory license suspension for at least one year. The second conviction will cost you your license for good.

Q. How will the licensing agency be notified of forfeiture or suspension?

A court will enter an order of license forfeiture or suspension immediately after a plea of guilty or finding the defendant guilty, assuming any of this happens in New Jersey. The order is effective as of the date of conviction r guilty plea. If it is an out of state or a federal conviction, or the defendant forfeited his license in another state, the court will enter the forfeiture order upon application of the county prosecutor or the Attorney General.

Q. May a license forfeiture order be stayed while the case is pending appeal?

An order of license forfeiture or suspension will usually not be stayed pending appeal of a conviction or forfeiture or suspension order unless the appellant's attorney convince the court that there is a substantial likelihood of success on the merits. If the appeal is successful and the conviction is reversed or the order of license forfeiture or suspension is overturned, the court will notify the licensing agency within 10 days of the date of the order of reinstatement. That does not guarantee that the license will be restored because the agency, such as the New Jersey Board of Medical Examiners, may decide to suspend or revoke the license on its own motion.

Q. May a professional license be forfeited or suspended by a licensing agency?

Absolutely! This can be done through a special application by the Attorney General. The situation may arise in a case where the issue of license forfeiture or suspension is not even discussed raised in a court when the practitioner pleads guilty or is found guilty. However, the fact that a court has not ordered license forfeiture or suspension does not stop the licensing agency from doing that on its own accord. The decision may be based on the argument that the conduct giving rise to the conviction demonstrates that the person is unfit to hold the license or is otherwise liable for an offense.

Q. Can a professional or medical license be reinstated in New Jersey?

N.J.S.A. 2C:52-27.1(a) provides the procedure for reinstatement of forfeited professional licenses. If the conviction record is expunged, the convicted practitioner who lost his or her license as the result of conviction may ask the court for an order to rescind the court's order of forfeiture if the person can demonstrate that he or she is sufficiently rehabilitated. If an order to rescind the court's order of debarment is granted, the next step is to apply to the licensing agency for license reinstatement.

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Joseph Potashnik has sinced written about articles on various topics from Legal Matters, Dental Practice and Legal Matters. This article discusses New Jersey insurance fraud and is provided by Joseph Potashnik, a New Jersey criminal defense attorney who concentrates on insurance fraud and Medicaid fraud defense. Please visit his New Jersey criminal defense website at. Joseph Potashnik's top article generates over 60500 views. Bookmark Joseph Potashnik to your Favourites.

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