Is Your New Jersey Employer or other Medical Provider Guilty of Medicaid Fraud?

Medicaid is a partnership between the State of New Jersey and Federal governments that provides health benefits to low-income individuals and those with limited resources. It is estimated that fraud and abuse account for up to 10% of all Medicaid expenditures annually, costing taxpayers billions per year and driving up the costs of healthcare for everyone.

Government resources dedicated to fighting Medicaid fraud are limited, but individuals working in the health care arena and patients can increase the effectiveness and impact of those resources substantially as they are in the position to gain inside information on Medicaid waste, fraud and abuse. New Jersey State and Federal False Claims Acts provide whistleblowers with powerful protection and impressive financial incentives to take initiative when they detect fraudulent activity.

If you have information regarding Medicaid Fraud, you may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

Review the Various Types of Medicaid Fraud

Reporting New Jersey Medicaid Fraud

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What New Jersey Laws Apply to Reporting Medicaid Fraud?

The New Jersey Health Care Claims Fraud Act, N.J.S.A. 2C:21-4.2 et seq., makes it a crime for providers to submit false claims for payment or reimbursement of health care services. Penalties include monetary penalties, imprisonment and loss or suspension of license.

This Act provides the following criminal penalties for health care claims fraud, including the submission of false claims to programs funded in whole or in part with state funds:

  • A practitioner who knowingly commits health care claims fraud in the course of providing professional services is guilty of a crime of the second degree, and is subject to a fine of up to 5 times the monetary benefits obtained or sought to be obtained and to permanent forfeiture of his license;
  • A practitioner who recklessly commits health care claims fraud in the course of providing professional services is guilty of a crime of the third degree, and is subject to a fine of up to 5 times the pecuniary benefit obtained or sought to be obtained and the suspension of his license for up to 1 year;
  • A person who is not a practitioner subject to paragraph a. or b. above (for example, someone who is not licensed, registered or certified by an appropriate State agency as a health care professional) is guilty of a crime of the third degree if that person knowingly commits health care claims fraud. Such a person is guilty of a crime of the second degree of that person knowingly commits 5 or more acts of health care claims fraud, and the aggregate monetary benefit obtained or sought to be obtained is at least $1,000. In addition to all other criminal penalties allowed by law, such a person may be subject to a fine of up to 5 times the monetary benefit obtained or sought to be obtained; or
  • A person who is not a practitioner subject to paragraph a. or b. above is guilty of a crime of the fourth degree if that person recklessly commits health care claims fraud.  In addition to all other criminal penalties allowed by law, such a person may be subject to a fine of up to 5 times the monetary benefit obtained or sought to be obtained.

The New Jersey Medical Assistance and Health Services Act, N.J.S.A. 30:4D-1 et seq., disallows the submission of false claims to the Medicaid program, penalties for which include imprisonment, fines of up to three times the amount of excess payment received, potential exclusion from Medicaid program participation, and a civil penalty equal to between $5,500 and $11,000 per false claim.

Combatting Medicaid Fraud is a crucial step in safeguarding our nation’s health care for future generations. Medicaid fraud harms everyone. If you suspect Medicaid Fraud is occurring in your place of business, you are protected by federal and state law and may be entitled to a substantial case award for your information. Contact the Medicaid Fraud Hotline Now.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

Does New Jersey Law Provide Protection For Those Reporting Medicaid Fraud?

Whistleblower Protections under the New Jersey False Claims Act 

The New Jersey False Claims Act (NJFCA) has strong anti-retaliation provisions to protect employees who try to stop fraudulent activity.Specifically, the NJFCA provides protection to private parties who are discharged, demoted, suspended, threatened, harassed, denied promotion or in any other manner discriminated against in the terms and conditions of their employment as a result of their disclosure of information to the State or furtherance of an action under the NJFCA.

Individuals who qualify for protection against employer retaliation under the NJFCA may include:

  • Individuals filing a whistleblower claim against their employer or medical provider
  • Individuals who intend to file a whistleblower claim against their employer or medical provider
  • Agents or contractors who aid the whistleblower in reporting the fraud
  • Individuals who had no intent to file a whistleblower lawsuit, but reported the fraudulent activity internally (to a manager or supervisor) in an attempt stop the fraudulent activity

Whistleblowers Are Entitled To Remedies When Subjected to Employer Retaliation

Under the NJFCA, whistleblowers who experience workplace retaliation are entitled to all damages essential to “make the employee whole.” These remedies include:

  • Reinstatement of your position with comparable seniority as you would have but for the discrimination
  • Two times the amount of any back pay lost during change in position
  • Interest on any back pay lost during change in position
  • Reasonable attorneys’ fees and other litigation costs incurred
  • Possible compensation for other damages directly resulting from the discrimination

Whistleblower Protections under New Jersey’s Conscientious Employee Protection Act

New Jersey healthcare employees are protected against retaliation in the workplace by the New Jersey Conscientious Employee Protection Act (CEPA), also referred to as New Jersey’s whistleblower protection statute. CEPA prohibits employers from taking retaliatory action against an employee when the employee reports information involving an employer’s illegal or fraudulent activity or refuses to participate in the employer’s illegal or fraudulent activity.

Retaliation against an employee can take many different forms. Under CEPA, retaliatory acts are defined as “discharge, suspension, or demotion of an employee, or any other adverse employment action taken against the employee with regard to the terms and conditions of employment.”

If an employer violates CEPA, several remedies are available to the defendant, including:

  • Injunction against the employer to discontinue illegal activity
  • Reinstatement to the same or equivalent position
  • Reinstatement of benefits and rights associated with employment
  • Monetary damages for lost wages and benefits
  • Reasonable attorneys’ fees
  • Possible punitive damages when eligible

The Conscientious Employee Protection Act (CEPA), N.J.S.A. 34:19-4, protects whistleblowers from employee punishment or other retaliation. New Jersey law prohibits an employer from taking any retaliatory action against an employee, including when the employee:

  • Discloses, or threatens to disclose, to a supervisor or to a public body an activity, policy or practice of the employer or another employer, with whom there is a business relationship, that the employee reasonably believes is in violation of a law, or a rule or regulation issued under the law, or, in the case of an employee who is a licensed or certified health care professional, reasonably believes constitutes improper quality of patient care;
  • Provides information to, or testifies before, any public body conducting an investigation, hearing or inquiry into any violation of law, or a rule or regulation issued under the law by the employer or another employer, with whom there is a business relationship, or, in the case of an employee who is a licensed or certified health care professional, provides information to, or testifies before, any public body conducting an investigation, hearing or inquiry into quality of patient care;
  • Provides information involving deception of, or misrepresentation to, any shareholder, investor, client, patient, customer, employee, former employee, retiree or pensioner of the employer or any governmental entity;
  • Provides information regarding any perceived criminal or fraudulent activity, policy or practice of deception or misrepresentation which the employee reasonably believes may defraud any shareholder, investor, client, patient, customer, employee, former employee, retiree or pensioner of the employer or any governmental entity; or
  • Objects to, or refuses to participate in, any activity, policy or practice which the employee reasonably believes: (1) is in violation of a law, or a rule or regulation issued under the law or, if the employee is a licensed or certified health care professional, constitutes improper quality of patient care; (2) is fraudulent or criminal; or (3) is incompatible with a clear mandate of public policy concerning the public health, safety or welfare or protection of the environment. N.J.S.A. 34:19-3.

The protection against retaliation, when disclosure is made to a public body, does not apply unless the employee has brought the activity, policy or practice to the attention of a supervisor of the employee by written notice and given the employer a reasonable opportunity to correct the activity, policy or practice. Disclosure is not required when the employee reasonably believes that the activity, policy or practice is known to one or more supervisors of the employer or where the employee fears physical harm as a result of the disclosure, provided that the situation is emergency in nature.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

What Cash Awards Are Available for Reporting New Jersey Medicaid Fraud?

The NJFCA, N.J.S.A. 2A:32C-1 et seq., allows private citizens to file suit on behalf of the state of New Jersey against wrongdoers and awards whistleblowers anywhere from 15-30% of the financial recovery obtained through a successful settlement or verdict.

The NJFCA provides a means for the State of New Jersey to prosecute medical providers or companies that have made fraudulent claims for payment. While fraud against the state arises in many industries, a large majority of the taxpayer’s monies recovered come from hospitals, medical providers and companies engaged in fraud related to Medicare and Medicaid false billings.

The government’s ability to successfully prosecute cases under the False Claims Act is largely dependent on a whistleblower coming forward to expose a company’s or medical provider’s fraud. In 2014, approximately $3 billion dollars of the total recoveries made through the Federal False Claims Act were the result of a whistleblower coming forward. In 2014, the nation’s whistleblowers received $435 million of the $3 billion dollars recovered by the federal government as a result of their disclosures.

Medicaid Fraud Hotline: 888.742.7248 or Report Online

What is the New Jersey Statute of Limitations on Reporting Medicaid Fraud?

Under current New Jersey law, a NJFCA action may only be brought:

  • Within 6 years of the alleged fraudulent act OR,
  • Within 3 years after the date when the facts material to the case should have been known, BUT
  • With an absolute maximum limitation of 10 years of the alleged fraudulent act – whichever occurs last.
Medicaid Fraud Hotline: 888.742.7248 or Report Online

3 Easy Steps to Help you Decide

Whether You Should Report Medicaid Fraud

If you have information regarding Medicaid Fraud in the State of New Jersey, contact the Medicaid Fraud Hotline or fill out the online report form. Time is of the essence as you must be the first to act to secure your role as whistleblower and be eligible for a cash award. Statutes of limitations (how much time can pass before you can’t report anymore) apply.

Over $1 Million in Cash Awards for Tips Leading to Government Recovery
Medicaid Fraud Hotline: 888.742.7248 or Report Online