In the latest case of NJ prosecutors coming down hard on insurance fraud, four New Jersey residents were recently indicted for health care fraud after they allegedly faked a car accident and filed false medical treatment claims.
The criminal indictments were announced by the NJ Office of the Attorney General and the NJ Office of the Insurance Fraud Prosecutor. These offices worked together on this investigation.
According to these prosecutors, the suspects charges staged a car accident by intentionally crashing a Honda Civic into another car. The suspects then allegedly filed separate Personal Injury Protection (PIP) claims with Liberty Mutual Insurance Company seeking more than $48,000 in medical payouts. The insurance company suspected fraud, refused to pay the health care claims, and notified the Office of the Insurance Fraud Prosecutor.
Investigators uncovered this alleged scam and these four individuals were charged with a number of crimes, including health care fraud, conspiracy and theft by deception.
Health care claims fraud and insurance fraud are white collar crimes that carry severe penalties in New Jersey, including serious prison time. Under NJ law, as set forth by N.J.S.A. 2C:21-4.3(a), a person can be charged with health care claims fraud if they knowingly made a false, fictitious, fraudulent or misleading statement of material fact in any document seeking compensation or reimbursement on a health care-related insurance claim.
The classification of this charge, as well as its potential penalties, is determined by the circumstances of the fraudulent activity. For example, a person can be charged with second degree insurance fraud only if they commit a minimum of five acts of insurance fraud and the value of the insurance benefits exceeds $1,000. In this case, the suspects were charged with second degree health care claims fraud because each act of insurance fraud contained within a single claim constituted a separate act of fraud under the law.
This NJ prosecutorial practice of turning a single false claim into multiple acts of fraud is a clever way to apply pressure to defendants and increase the penalties for insurance fraud. Since the grand jury in this case indicted these individuals on second degree insurance fraud, each suspect faces up to 10 years in New Jersey State Prison if they are ultimately convicted or plead guilty to these charges.
Health Insurance Fraud Investigations
Health insurance fraud is a major problem in New Jersey and the rest of the country, with fraudulent accident injury claims costing insurance companies large amounts of money each year. As a result, many health insurance providers are cracking down on fraud by utilizing in-house investigators to look into suspicious claims and uncover scams. These days, some insurance companies have a default policy of viewing all claims with a skeptical eye.
There have been many cases of legitimate accident victims being accused of insurance fraud. If you suspect that your insurance carrier is investigating you for supposedly filing a fraudulent claim, it is imperative that you speak with a knowledgeable criminal defense attorney before you make any statements or admissions to investigators.
If you or a loved one has been accused of insurance fraud, theft by deception or any other fraud-related crime in New Jersey, the experienced criminal defense lawyers at Bramnick, Rodriguez, Grabas, Arnold & Mangan, LLC can help you. Call us today for a free consultation about your case.