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graduated rule
  Fraud Examples  

Medicaid Fraud

  • It's illegal to participate in a scheme to offer or receive kickbacks in connection with the furnishing of items or services which are billable to the Medicaid program.
  • It's illegal to over bill Medicaid for services provided.
  • It's illegal to receive more Medicaid benefits than you're entitled to.
  • These are violations of N.J.S.A. 30:4D-17.
  • Punishable by up to 3 years in prison and a $10,000 penalty.
  • They may also be violations of the Health Care Claims Fraud Act and other criminal statutes.

Health Care Claims Fraud

  • It's illegal to submit a false claim form to an insurance company in order to be paid for health care services which were not received or provided.
  • This is a violation of the New Jersey Health Care Claims Fraud Act, N.J.S.A. 2C:21-4.2 and 2C:21-4.3.
  • In addition, this person can be required to pay a fine of up to $150,000 or up to five times the amount of the claim.
  • A person who is not a doctor, chiropractor, etc., could be sentenced to 3 to 5 years in jail for filing just one false claim.
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