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Preventing & Reporting Health Care Fraud

Know the signs. Prevent & report fraud.
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.


  • Suspect or know of someone committing Health Insurance Fraud?
    Report it here
    to the New Jersey Office of the Insurance Fraud Prosecutor.
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.


  • Suspect or know of someone committing Medicaid Fraud or Elder Abuse & Neglect?
    Report it here
    to the New Jersey Medicaid Fraud Control Unit.
Medicare Fraud
    • A health care provider bills Medicare for services you never received.


    • A supplier bills Medicare for equipment you never got.


    • Someone uses another person’s Medicare card to get medical care, supplies, or equipment.


    • Someone bills Medicare for home medical equipment after it has been returned.


    • A company offers a Medicare drug plan that has not been approved by Medicare.


    • A company uses false information to mislead you into joining a Medicare plan.


  • Suspect or know of someone committing Medicare Fraud? 
    Report it here
    to the United States HHS Office of Inspector General.