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What is Medicaid fraud and what are the penalties in New Jersey?

March 21, 2024 Uncategorized

 

What is Medicaid Fraud and What are the Penalties in New Jersey?

Medicaid fraud is a big problem in New Jersey and across the country. Basically, Medicaid fraud is when someone lies or withholds information to get Medicaid benefits they aren’t entitled to. There are different types of Medicaid fraud, with different penalties, but they all involve some form of dishonesty or deception.

Some examples of Medicaid fraud include:

  • Billing for services that were never provided
  • Billing for unnecessary services
  • Billing for services at a higher rate than is allowed
  • Billing multiple times for the same service
  • Falsifying diagnoses to justify tests or procedures
  • Accepting kickbacks for patient referrals
  • Using someone else’s Medicaid card
  • Hiding income or assets to qualify for Medicaid

As you can see, there are lots of different ways providers or recipients can try to cheat the system. Medicaid fraud costs taxpayers billions of dollars every year. So it’s taken very seriously by investigators and prosecutors in New Jersey.

Penalties for Medicaid Fraud in New Jersey

The penalties for Medicaid fraud in New Jersey vary based on the exact nature of the offense. But in general, those convicted of Medicaid fraud face:

  • Up to 10 years in prison per offense
  • Fines up to $150,000 per offense
  • Having to repay up to triple the amount of damages
  • Loss of professional license

Let’s break down some of the specific laws and penalties in more detail:

Criminal Medicaid Fraud

In New Jersey, criminal Medicaid fraud charges often fall under the state’s Health Care Claims Fraud Act (N.J.S.A. 2C:21-4.2 and 2C:21-4.3). This covers offenses like:

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Christine Twomey
2024-03-21
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Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
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Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
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Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
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2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
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2024-03-12
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Bee L
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2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
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2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.
  • Billing for services not performed
  • Misrepresenting what services were provided
  • Upcoding (billing for more expensive services than were rendered)

For even a single offense under this act, penalties can include:

  • 3-5 years in prison
  • Fines up to $150,000
  • Having to repay up to triple damages

So if a doctor billed Medicaid for $50,000 worth of procedures he didn’t actually perform, he could end up paying $150,000 in fines plus another $150,000 in damages – yikes!

Felony Medicaid Fraud

More serious or large-scale Medicaid fraud is often charged as a felony under federal law. This includes offenses like:

  • Billing over $1 million in false claims
  • Committing Medicaid fraud as part of an organized criminal group
  • Receiving kickbacks for Medicaid referrals

Penalties for felony Medicaid fraud can include:

  • Up to 10 years in federal prison per offense
  • Fines up to $250,000 for individuals or $500,000 for corporations
  • Having to repay up to triple damages

In addition to fines and prison time, those convicted of felony Medicaid fraud often face federal supervision after release and forfeiture of any assets connected to the fraud.

Medicaid Eligibility Fraud

Lying on a Medicaid application to obtain benefits you aren’t entitled to is considered Medicaid eligibility fraud. This could involve:

  • Failing to report income or assets
  • Claiming dependents who don’t live with you
  • Using someone else’s Medicaid card

If convicted, penalties for Medicaid eligibility fraud may include:

  • Up to 6 months in county jail
  • Fines up to $1,000
  • Having to repay benefits received
  • Bar from receiving Medicaid for 1 year

While less severe than other forms of Medicaid fraud, eligibility fraud is still a crime that carries real consequences.

Loss of Professional Licensure

For doctors, nurses, pharmacists and other licensed providers convicted of Medicaid fraud, loss of their professional license is often the biggest blow. New Jersey requires strict background checks for licensure. So any felony conviction or fraud conviction will make it very difficult to ever practice in the state again.

How New Jersey Detects and Deters Medicaid Fraud

With billions lost to Medicaid fraud every year, New Jersey deploys a wide range of tools to detect and deter fraud, including:

  • Data mining to identify abnormal billing patterns
  • Audits of Medicaid providers and claims
  • Undercover operations and sting investigations
  • Review of patient complaints
  • Analysis of tips and whistleblower reports

The state has also launched public education campaigns to increase awareness of Medicaid fraud and its consequences. And specialized Medicaid Fraud Control Units work with federal investigators to identify and prosecute fraud.

With so many eyes watching, those considering Medicaid fraud in New Jersey should think again. The penalties simply aren’t worth the risk.

For providers, the best protection against fraud allegations is to follow proper billing practices, document services accurately, and avoid questionable arrangements like kickbacks. If unsure whether a certain billing or referral practice is above board, consult with an attorney.

For recipients, be upfront about your household income, assets, and living situation when applying for Medicaid. If these change after you’ve been approved, report it promptly to avoid any penalties down the road.

Medicaid fraud cheats taxpayers, drives up healthcare costs, and deprives needy patients of benefits. So if you suspect Medicaid fraud, report it right away. This will protect the integrity of an essential program for New Jersey’s most vulnerable residents.

References

Learn more about Medicaid fraud and penalties in New Jersey:

 

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