NJ Healthcare Fraud Lawyers
Healthcare providers in New Jersey always have to be careful how they conduct themselves. This is especially true where filing insurance company and Medicare or Medicaid claims are involved. Thanks to state and federal laws, any healthcare provider who is involved with Medicaid or Medicare claims can find that their health care records may be reviewed at any time on demand by governmental agencies and investigators. Besides these groups, any corporations which possess contracts with the government are under obligations courtesy of the fine print in their contracts to cooperate with the government in any investigation conducted regarding healthcare fraud.
Individuals and Entities Who Can Be Accused of Healthcare Fraud
It is not only doctors and their offices and staff who can be accused of healthcare fraud by insurance companies and the state and federal governments. In fact groups and individuals as diverse as major and minor pharmaceutical companies, hospitals, home healthcare providers, nursing homes, labs, suppliers of durable medical equipment, providers of medical transportation, and rehab facilities can all have accusations and charges of healthcare abuse and fraud leveled against them by investigators from the Federal or State governmental agencies. This is why it is so critically important for any one or entity accused of medical fraud or abuse to engage an experienced and qualified healthcare fraud attorney when they are contacted by payor queries and government inquiries.
Need Help With Your Case?
Don't face criminal charges alone. Our experienced defense attorneys are ready to fight for your rights and freedom.
- 100% Confidential
- Response Within 1 Hour
- No Obligation Consultation
Or call us directly:
(212) 300-5196General Areas Where Fraud Accusations May Occur
Accusations and investigations can occur in any number of areas regarding billing or potential fraud. Some of the more common instances include:
Todd Spodek
Lead Attorney & Founder
Featured on Netflix's "Inventing Anna," Todd Spodek brings decades of high-stakes criminal defense experience. His aggressive approach has secured dismissals and acquittals in cases others deemed unwinnable.
You are a physician running a busy medical practice in Newark when you receive a letter from the Office of Inspector General stating that your billing patterns for certain diagnostic tests are under investigation for potential Medicare fraud. Your office manager tells you that for the past two years, they have been upcoding certain procedures to maximize reimbursements without your explicit knowledge.
Can I be held personally liable for healthcare fraud committed by my office staff, even if I didn't know about the fraudulent billing?
Under both New Jersey's Healthcare Claims Fraud Act (N.J.S.A. 2C:21-4.2 and 4.3) and the federal False Claims Act (31 U.S.C. § 3729), you can face liability even if you were not directly involved in the fraudulent billing, because the law imposes a duty on healthcare providers to ensure the accuracy of claims submitted under their name and provider number. Penalties can include treble damages, fines of up to $11,000 per false claim under the federal False Claims Act, exclusion from Medicare and Medicaid programs, and potential criminal charges carrying prison time. The federal Anti-Kickback Statute and New Jersey's own fraud statutes create layers of exposure that make it critical to act immediately. You need experienced healthcare fraud defense counsel right away to conduct an internal audit, preserve relevant documents, and develop a strategy before responding to the OIG — early intervention can sometimes lead to negotiated resolutions that avoid criminal prosecution entirely.
This is general information only. Contact us for advice specific to your situation.
- Medicaid, Medicare and third-party paying companies and their charges that they were overbilled for claims.
- Health and Human Services Office of the Inspector General and Department of Justiceinvestigations of violations in Medicare billing regulations.
- State agencies and Office of the Inspector General of Health and Human Services civil monetary fines and penalties.
