[vc_row][vc_column][vc_column_text]Healthcare providers in New Jersey always have to be careful how they conduct themselves. This is especially true where filing insurance company and Medicare or Medicaid claims are involved. Thanks to state and federal laws, any healthcare provider who is involved with Medicaid or Medicare claims can find that their health care records may be reviewed at any time on demand by governmental agencies and investigators. Besides these groups, any corporations which possess contracts with the government are under obligations courtesy of the fine print in their contracts to cooperate with the government in any investigation conducted regarding healthcare fraud.
Individuals and Entities Who Can Be Accused of Healthcare Fraud
It is not only doctors and their offices and staff who can be accused of healthcare fraud by insurance companies and the state and federal governments. In fact groups and individuals as diverse as major and minor pharmaceutical companies, hospitals, home healthcare providers, nursing homes, labs, suppliers of durable medical equipment, providers of medical transportation, and rehab facilities can all have accusations and charges of healthcare abuse and fraud leveled against them by investigators from the Federal or State governmental agencies. This is why it is so critically important for any one or entity accused of medical fraud or abuse to engage an experienced and qualified healthcare fraud attorney when they are contacted by payor queries and government inquiries.
General Areas Where Fraud Accusations May Occur
Accusations and investigations can occur in any number of areas regarding billing or potential fraud. Some of the more common instances include:
• Medicaid, Medicare and third-party paying companies and their charges that they were overbilled for claims.
• Health and Human Services Office of the Inspector General and Department of Justice investigations of violations in Medicare billing regulations.
• State agencies and Office of the Inspector General of Health and Human Services civil monetary fines and penalties.
New Jersey’s Procedures when State Healthcare Fraud is Suspected or Uncovered by Insurance Companies
Unfortunately for healthcare providers who have done nothing at all wrong, fraud with healthcare claims is an all too common occurrence in the state of New Jersey. Patients can be accused of stealing a few extra dollars from insurance companies while doctors or hospitals might be investigated for conspiracies in the millions of dollars. In other words, charges of healthcare abuse and fraud can enmesh any person or entity in New Jersey. These investigations are serious when they start, even if they are not begun by a governmental agency or law enforcement but instead originate with an insurance company.
The fact of the matter is that insurance companies often uncover or make accusations of medical and healthcare fraud. This is in part because they have the dedicated staff to the tune of even dozens of investigators who spend their every day working hours looking into healthcare fraud. This has major repercussions for two different reasons. The first of these is that anything at all which a person relays to such investigators can and will likely be used against them at some point in the future. The second point is that attorneys who specialize in healthcare fraud can often enter negotiations with investigators from insurance companies to come to an amenable civil resolution to any and all allegations and accusations. This could potentially avoid the unpleasantries of having to see the investigation turned over to the government regulatory authorities for criminal prosecution.
In the event that the case still makes its way over to the Feds or state authorities, there would be significant lead time before government investigation and prosecution got underway. That would permit the healthcare fraud lawyer to have more than ample time to begin preparations to defend their client against any pending prosecution even before law enforcement received calls from the insurance agency investigators. Any healthcare provider or professional who is in trouble with either an insurance agency or law enforcement group should speak with a highly-qualified and reputable New Jersey Healthcare Fraud lawyer as soon as possible.
New Jersey is aggressive in its prosecution of any fraudulent or abusive healthcare claims that come across its investigators’ desks. Their section of Government and Healthcare Fraud employs the New Jersey False Claims Act to pursue investigations and prosecutions that pertain to state funds fraudulent requests. In this section, the investigators and their staff begin cases and similarly follow up on any information turned over as a result of Qui Tam suits that whistleblowers file against their employers or associates. Where consumer and investor protection issues and fraud are concerned, this section acts as representative of the Division and the State in both investigations and any subsequent litigation.
Consequences of Healthcare Fraud Allegations and Determinations
As the environment of regulations and regulators has evolved into a literal minefield for consumers and providers of health care, health care and insurance fraud cases can lead to significant civil and even criminal punishments. These can sometimes include:
• Revocation of professional licenses
• Fines and restitution
• Censure and public embarrassment
• Incarceration and loss of freedom
It is a sobering fact that such penalties pertaining to insurance fraud charges have become severe punishments. Medical providers and healthcare users alike should take these dangers very seriously. There is a real risk to both providers and users of healthcare in this regard made clear by the relatively new statute that authorizes the criminal investigation and prosecution of health care claims that they deem to be reckless in nature.
Services a New Jersey Healthcare Fraud Attorney Can Provide
New Jersey Healthcare fraud lawyers can help with a wide range of these medical fraud related issues and problems. Among these areas of expertise and assistance that they provide are:
• Investigations and defense for insurance fraud and abuse
• Defense and investigation of Medicare and Medicaid fraud and abuse
• Disciplinary hearings and judgments involving administrative actions for health care professionals and their licenses
• Joint work and co-development of defense for healthcare practices, medical offices, and hospitals in conjunction with their corporate law group responsible for healthcare issues
• Defending against Qui Tam actions and cases
• Analyzing and reviewing potential problems that come from Medicare excluding doctors and other healthcare providers from their network
Practitioners of medicine and healthcare have invested too many years of their lives and staggering amounts of resources in order to deliver their care to consumers. Charges leveled against these doctors, nurses, hospitals, health care groups, nursing homes, and others threaten to ruin all of their years of hard work, study, and practice, and to deprive them of their livelihood. This is why at the first sign of trouble from an insurance company fraud case investigator or with the very first contact by a state or Federal regulator or investigator, it is critically important to engage the services of the very best legal counsel that they can to help advise and guide them in how to appropriately respond as effectively as possible. No one person, practice, or medical group should suffer on their own through these charges when professional help is readily available.