Health Care Claims Fraud

New Jersey Health Care Claims Fraud Criminal Defense Attorney

Ms. Denholtz is a fierce criminal defense trial attorney with over a decade of experience. Ms. Denholtz offers relentless advocacy, strategic defense, and exceptional service to clients accused of White-Collar Offenses throughout New Jersey.

Ms. Denholtz handles her cases with exacting attention to detail and works tirelessly to ensure her clients receive the best possible outcome for their individualized situation. At Denholtz Criminal Defense, you can trust that your case will receive the meticulous attention and tireless advocacy it deserves. Ms. Denholtz is ready to fight for you. Contact Denholtz Criminal Defense today for your FREE consultation: (862) 842-0811 or Tracy@DenholtzCriminalDefense.com.

Health Care Claims Fraud

(N.J.S.A. 2C:21-4.3)

Practitioner Acts Knowingly: Under N.J.S.A. 2C:21-4.3(a), a practitioner is guilty of health care fraud if that person knowingly commits health care claims fraud in the course of providing professional services.

2nd Degree Offense: Health care claims fraud under N.J.S.A. 2C:21-4.3(a) is a crime in the 2nd degree which is punishable by up to 10 years in New Jersey State Prison.
Fine: In addition to all other criminal penalties allowed by law, a person convicted under this subsection may be subject to a fine of up to five times the pecuniary benefit obtained or sought to be obtained.

Practitioner Acts Recklessly: Under N.J.S.A. 2C:21-4.3(b) practitioner is guilty of health care claims fraud if that person recklessly commits health care claims fraud in the course of providing professional services.

3rd Degree Offense: Health care claims fraud under N.J.S.A. 2C:21-4.3(b) is a crime of the 3rd degree which is punishable by up to 5 years in New Jersey State Prison.
Fine: In addition to all other criminal penalties allowed by law, a person convicted under this subsection may be subject to a fine of up to five times the pecuniary benefit obtained or sought to be obtained.

Non-Practitioner Acts Knowingly: Under N.J.S.A. 2C:21-4.3(c), a person, who is not a practitioner is guilty of health care claims fraud if that person knowingly commits health care claims fraud.

2nd Degree Offense: A person, who is not a practitioner is guilty of a crime of the second degree if that person knowingly commits five or more acts of health care claims fraud and the aggregate pecuniary benefit obtained or sought to be obtained is at least $1,000. A 2nd degree offense is punishable by up to 10 years in New Jersey State Prison.
3rd Degree Offense: In all other cases, the non-practitioner is guilty of a crime in the 3rd degree. A 3rd degree offense is punishable by up to 5 years in New Jersey State Prison.
Fine: In addition to all other criminal penalties allowed by law, a person convicted under this subsection may be subject to a fine of up to five times the pecuniary benefit obtained or sought to be obtained.

Non-Practitioner Acts Recklessly: Under N.J.S.A. 2C:21-4.3(d), a person, who is not a practitioner is guilty of health care claims fraud if that person recklessly commits health care claims fraud.

4th Degree Offense: Health care claims fraud under N.J.S.A. 2C:21-4.3(d) is a 4th degree offense which is punishable by up to 18 months in New Jersey State Prison.
Fine: In addition to all other criminal penalties allowed by law, a person convicted under this subsection may be subject to a fine of up to five times the pecuniary benefit obtained or sought to be obtained.

*NOTE RE: Separate Offenses: Under N.J.S.A. 2C:21-4.3(e), each act of health care claims fraud shall constitute an additional, separate and distinct offense, except that 5 or more separate acts may be aggregated for the purpose of establishing liability pursuant to subsection c. of this section. Multiple acts of health care claims fraud which are contained in a single record, bill, claim, application, payment, affidavit, certification or other document shall each constitute an additional, separate and distinct offense for purposes of this section.

*NOTE RE: Inference of Fraud: Under N.J.S.A. 2C:21-4.3(f)(1), the falsity, fictitiousness, fraudulence or misleading nature of a statement may be inferred by the trier of fact in the case of a practitioner who attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted, any record, bill, claim or other document for treatment or procedure without the practitioner, or an associate of the practitioner, having performed an assessment of the physical or mental condition of the patient or client necessary to determine the appropriate course of treatment.

*NOTE RE: Inference of Fraud: Under N.J.S.A. 2C:21-4.3(f)(2), the falsity, fictitiousness, fraudulence or misleading nature of a statement may be inferred by the trier of fact in the case of a person who attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted any record, bill, claim or other document for more treatments or procedures than can be performed during the time in which the treatments or procedures were represented to have been performed.

*NOTE RE: Inference of Fraud: Proof that a practitioner has signed or initialed a record, bill, claim or other document gives rise to an inference that the practitioner has read and reviewed that record, bill, claim or other document.

Health Care Claims Fraud Definitions:

“Health Care Claims Fraud”: Under N.J.S.A. 2C:21-4.2(a), "health care claims fraud" means making, or causing to be made, a false, fictitious, fraudulent, or misleading statement of material fact in, or omitting a material fact from, or causing a material fact to be omitted from, any record, bill, claim or other document, in writing, electronically or in any other form, that a person attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted for payment or reimbursement for health care services.

“Practitioner”: Under N.J.S.A. 2C:21-4.2(b), "practitioner" means a person licensed in this State to practice medicine and surgery, chiropractic, podiatric medicine, dentistry, optometry, psychology, pharmacy, nursing, physical therapy, or law; any other person licensed, registered or certified by any State agency to practice a profession or occupation in the State of New Jersey or any person similarly licensed, registered, or certified in another jurisdiction.

"Acting Recklessly": For the purposes of this section, a person acts recklessly with respect to a material element of an offense when he consciously disregards a substantial and unjustifiable risk that the material element exists or will result from his conduct. The risk must be of such a nature and degree that, considering the nature and purpose of the actor's conduct and the circumstances known to him, its disregard involves a gross deviation from the standard of conduct that a reasonable person would observe in the actor's situation.

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The consequences of a criminal conviction can be devastating. It can impact employment, housing, finances, education, reputation, and relationships. Criminal cases are also very complex and highly specialized. If you or a loved one are facing criminal charges, it is crucial to hire an experienced criminal defense attorney.

At Denholtz Criminal Defense, we understand the stakes involved and are committed to providing you with skilled, aggressive, and personalized legal representation. No matter what the allegations, Ms. Denholtz will provide an honest and detailed evaluation of your case, outline the best legal options available, and craft a defense strategy designed to achieve the best possible result for your unique situation. Contact Denholtz Criminal Defense today for your free consultation: (862) 842-0811 or Tracy@DenholtzCriminalDefense.com.