New Jersey Insurance Fraud Crimes Through the Eyes of a New Jersey Fraud Defense Lawyer

When we mention crime, even white-collar crime,where licensed agents steal insurance premiums
insurance fraud is not what immediately comes toor are engaged in fraudulent premium financing
mind. Yet, insurance fraud has lately become oneschemes.
of the front-runners among the most oftenAnother large area that pays bills for New Jersey
prosecuted white-collar crimes in New Jersey.insurance fraud criminal defense attorneys is
In fact, New Jersey has the toughest criminalHealth Care insurance fraud. Most such cases
insurance fraud statutes in the country. Theinvolve submitting fraudulent claims for payment
Health Care Claims Fraud statute, N.J.S.A. 21-4.3for health care services that were never provided
and the Insurance Fraud statute, N.J.S.A. 2C:21-4.6,and received. The most often targeted individuals
make many acts of insurance fraudhere are New Jersey doctors, dentists,
second-degree crimes. For starters, achiropractors, nurses, physical therapists,
second-degree crime in New Jersey carries with itpharmacists, and social workers.
a prison term of up to ten years and fines of upThe most widely used tool in New Jersey heal
to $150,000.care insurance fraud prosecutions is the Health
The vast majority of insurance fraud cases inCare Claims Fraud status, N.J.S.A. 2C:21-4.3 that
New Jersey are investigated and prosecuted bymakes it a crime for any health care provider
the Office of Insurance Fraud Prosecutor (OIFP)just to submit a false claim to insurance
and these cases involve all thinkable areas ofcompanies, no matter what the amount is. A
insurance fraud, including health, life, disability, auto,non-provider only needs to submit a false claim
homeowners’ or commercial insurancefor $1,000 to have committed a second-degree
coverages.crime. Other criminal charges used in prosecutions
According the 2007 OIFP report, there was "aof New Jersey health care insurance fraud cases
10% increase in criminal sentences over lastare usually charges of theft, conspiracy, and
year’s figure and sent defendants to prisonfalsifying records.
for a combined total of 147 years". The reportAnother area of New Jersey insurance fraud is life
exemplifies the wide array of individuals whoand disability insurance fraud, both governed by
found themselves in trouble for insurance fraud: "the Insurance Fraud Statute, N.J.S.A. 2C:21-4.6. Life
In 2007, OIFP recorded OIFP won convictions ofinsurance fraud offense is submitting a claim that
four former police officers, two of whom willfalsely represents death of a claimant or
serve a total of 12 years in State prison. Fourotherwise misrepresenting important facts
licensed health care providers received Stateconcerning the claim. Disability fraud involves
prison sentences totaling 12 years. A licensedfaking a non-existing condition in order to receive
insurance agent was sentenced to a five-yearbenefits or knowingly failing to disclose new
State prison term. An auto body shop owner andincome.
his accomplice were sent to State prison for aProbably the largest single area of New Jersey
total of nine years. The sentences imposed onInsurance Fraud is Medicaid fraud, which is
several members of vehicle theft rings totaled 77investigated and prosecuted by the OIFP's
years in State prison, over $1.8 million inMedicaid Fraud Section. New Jersey Medicaid Fraud
restitution, and $9,500 in civil insurance fraudcan be committed by any health care provider
fines". The list goes on.that participates in the Medicaid program. New
So, what is "insurance fraud" made of? One largeJersey physicians, dentists, clinics, chiropractors,
area of Insurance fraud in New Jersey ispharmacists, laboratories, nursing homes, etc. are
Automobile Insurance Fraud. The most popularroutinely prosecuted for New Jersey Medicaid
crime here is auto theft and "give up schemes",fraud.
where the owner or lessee of a car abandons theThe basic New Jersey Medicaid fraud crime
car or gives it up to a someone who agrees toinvolves billing the Medicaid program for services
dispose of the car. Next come staged accidentsthat were never provided or might not be
and fraudulent Personal Injury Protection Claimsprovided by the billing provider, or when the
and criminal use of "runners". These types ofamount billed exceeds the costs of services
cases normally involve organized rings ofperformed (over billing). Other Medicaid fraud
"runners", medical providers, and lawyers. Vehiclecharges in New Jersey may be associated with
Insurance policies in New Jersey provide medicalcharges of patient abuse and criminal neglect.
benefits for persons injured in car accidents asAnother related New Jersey Medicaid fraud area
part of Personal Injury Protection (PIP) coverage.is Medicaid prescription and drug diversion fraud.
PIP insurance typically covers diagnostic testingThis involves pharmacies billing Medicaid for drugs
and treatment for persons injured in automobilethat were not actually dispensed. Doctors, who
accidents. In many cases, uninjured passengerssometimes form "partnerships" with pharmacies
involved in accidents are contacted byto engage in this fraud, are understandably find
“runners” who convince them to filethemselves in deep trouble as well.
claims for “soft tissue” injuries, such asHome health care fraud is the last largely
“whiplash”. Such injuries are not easilyprosecuted New Jersey Medicaid fraud crime.
verifiable by x-rays and MRI. In the end,Medicaid pays for personal care provided for
“runners” receive their illegal commissions,eligible beneficiaries by certified home care
medical and chiropractic mills provide unnecessaryassistants, aides, and nurses, all of whom must be
medical services, including fake diagnostic andcertified and licensed by the State to participate in
treatment, for which they bill, and lawyers filethe program. Criminal activities in this are involve
unwarranted lawsuits.billing for services that were not provided,
Other case involving New Jersey Automobileemploying non-certified providers, and lying in the
Insurance Fraud are selling and buying fakecertification process.
insurance ID cards and insurance agent fraud