What Are the Penalties for Medicare Fraud in New Jersey
Find Out (Today) Why New Jersey Health Care Providers Trust Oberheiden, P.C.: (214)469-9009
It’s not easy to be a doctor in New Jersey anymore. Federal prosecutors from the U.S. Attorney’s Office in Camden, Newark, and Trenton have prosecuted more doctors than ever before. In fact, New Jersey has become such a hotbed for health care fraud take downs, arrests, and indictments that the Justice Department declared it one of nation’s seven regional task force centers and installed the Medicare Fraud Strike Force in the greater New Jersey area to further intensify and expand on Medicare Fraud investigations.
Unlike any law firm you might come across, Oberheiden PC attorneys almost exclusively focus their practice on protecting health care providers. We believe that the health care rules and negotiations with the FBI, OIG, and Justice Department are too complex to also represent clients in other cases such as drunk driving and domestic violence. Just like a spine surgeon would not parallel to his or her back-surgery practice also act as a dentist or podiatrist, we believe that effective health care fraud defense cannot be a mere hobby for a lawyer that also handles every other imaginable case. In hundreds of health care defense cases we have demonstrated our knowledge and experience when it comes to defending Medicare Fraud, Medicaid Fraud, kickback allegations, False Claims Act matters and the like. Call us today and see for yourself what a difference experience can make.
What Does the Government Have to Prove in New Jersey Medicare Fraud Cases?
Medicare Fraud is a federal offense. Pursuant to 18 U.S.C. 1347, a person is criminally guilty of health care fraud in New Jersey federal court if the government can prove beyond a reasonable doubt that the following elements exist:
- The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a health care benefit program or obtain money or property from a health care benefit program by means of false or fraudulent pretenses, representations, or promises;
- The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the health care benefit program; and
- The defendant acted with the intent to defraud the health care benefit program.
Because health care fraud and Medicare fraud are federal offenses, violations are typically investigated by New Jersey-based federal law enforcement agencies such as the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG), the New Jersey Medicaid Fraud Control Unit (MFCU), and prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office in Camden, Trenton, or Newark.
What Are the Penalties for Criminal Medicare Fraud in New Jersey?
If you have any questions regarding the penalty calculation for Medicare Fraud in New Jersey or need to get guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Avoid these consequences, call (214)469-9009.
In New Jersey, a defendant convicted of Medicare fraud at trial or a defendant who decided to plead guilty to 18 U.S.C. 1347 is subject to severe penalties. These penalties are calculated based on the Federal Sentencing Guidelines. Pursuant to Title 18 of the United States Code, a defendant guilty of health care fraud will be ordered to not more than 10 years imprisonment per count, a term of supervised release, criminal fines; asset forfeiture, and a mandatory special assessment. In health care cases, the exact penalty depends on the alleged damage amount. For example, if the government can prove damages to CMS/Medicare in the hundreds of thousands of dollars or even millions, then the exposure can be truly significant as the following case examples show.
- A doctor in New Jersey has pleaded guilty to his role in a scheme to defraud Medicare. According to the plea agreement, the doctor would provide free lunches and spa services to Medicare beneficiaries in order to entice them to become patients at his practice. The doctor would then perform services on these patients that were not medically necessary and bill the services for reimbursement to Medicare. The doctor also used the patients’ information to bill Medicare for services that were never provided. As a result of the scheme, the doctor received $3.4 million in proceeds from the fraudulent billings.
- A hospital in New Jersey has agreed to a monetary settlement with the United States to resolve allegations that it defrauded Medicare. According to the settlement, the hospital is alleged to have inflated its billings for certain services to take advantage of Medicare’s supplemental reimbursement program. The supplemental reimbursement program was enacted to ensure Medicare patients would be covered if their required treatments involved high costs. The hospital allegedly falsified patient charts to reflect diagnoses that required services covered under the supplemental reimbursement program. The inflated billings were then sent to Medicare for reimbursement. To settle the allegations, the hospital will pay $6.3 million back to Medicare. Since this case was resolved with a settlement, there has been no finding of liability against the hospital.
- A New Jersey physician pleaded guilty to his role in a scheme to defraud Medicare. According to the plea agreement, the doctor took bribes from a diagnostic lab in exchange for referring patients for lab tests. The doctor specifically referred his Medicare patients for lab testing. The doctor admitted the most the patients he referred for lab tests did not medically require such tests. In order to try and conceal the bribe payments, the doctor and the lab entered into a sham lease agreement for certain rental space. As a result of the scheme, the doctor received almost $2 million in illegal bribes from the lab.
- A cardiovascular group in New Jersey has agreed to a monetary settlement with the United States to resolve allegations that it engaged in a scheme to defraud Medicare. The settlement involves allegations that the cardiovascular group submitted claims to Medicare for certain cardiac procedures that were not medically necessary based on the patients presenting symptoms and subsequent diagnoses. As a result of the settlement, the cardiovascular group will pay $3.6 million back to Medicare. Since this case was resolved via a settlement, there has been no finding of liability against the cardiovascular group.
- A NJ medical device company has agreed to a settlement with the United States for its alleged role in a kickback scheme that defrauded Medicare. The settlement resolves allegations that the device company paid doctors bribes in exchange for the doctors ordering their medical equipment from the device company. The sales of medical equipment to the doctors was then billed to Medicare for reimbursement. As a result of the settlement, the device company will pay $6 million to Medicare. Since this case was resolved via a settlement, there has been no finding of liability against the medical device company.
What Is the Statute of Limitations for Medicare Fraud in New Jersey?
In New Jersey federal criminal health care fraud investigations, the Statute of Limitations is typically five years. However, 18 U.S.C. 3282 is subject to various exceptions that can prolong the allowable prosecution phase, in particular if the case is charged as a federal health care fraud conspiracy.
What Are the Penalties for Civil Medicare Fraud in New Jersey?
The U.S. Attorney’s Office in New Jersey investigates civil and criminal Medicare cases. In civil Medicare audits, health care businesses often receive an Office of Inspector General subpoena requiring the production of documents and information to assist the government in those fraud investigations where no criminal intent is assumed.
If your New Jersey practice received a subpoena from the Department of Health and Human Services, Office of Inspector General, then you are likely accused of submitting false and fraudulent claims, physician self-referrals, kickbacks, drug price reporting, and other violations committed without criminal intent. Many civil Medicare fraud cases are reported by former employees under the federal False Claims Act.
Under the Civil Monetary Penalty Law (CMPL) violations have recently increased from previously $ 10,000 to now $ 20,000 per false claim.
Oberheiden PC lawyers have rebutted civil fraud allegations across the United States. Call us at (214)469-9009 and see how we can protect your business and your assets.
Call Oberheiden, P.C. at (214)469-9009
Oberheiden, P.C. has substantial experience in defending providers and owners of health care practices. Call us today, including on weekends, and speak to senior attorneys right away that will not waste your time with complicated secretarial scheduling or junior lawyers. We have successfully represented:
- Mobile Ambulance Transportation Cases
- Mobile Radiology Services
- Home Health Care Agency (Form 485 Cases)
- Hospice Care Representation
- Illegal Kickbacks
- Any Form of Medicare Fraudulent Billing
- Mental Health Care Providers
- Dialysis Centers
- Family Medicine Doctors
- Internal Medicine Specialists
- Pain Management Doctors
- Medicare Clinic Owners