Office of the Insurance Fraud Prosecutor

What is Insurance Fraud?

What is Insurance Fraud?

It’s a CRIME.

Who Commits Insurance Fraud in NJ?

“With possible exception of murder and drug abuse, no serious crime attracts as wide a variety of perpetrators as insurance fraud. People who would never think of robbing a bank, stealing a car or burglarizing a home can find the temptations of “easy money” from insurance fraud hard to resist.The files of the Office of Insurance Fraud Prosecutor demonstrate that Insurance Fraud is crime committed by people in a wide range of occupations.”

Fraud Examples

Auto Accidents
arrow It’s illegal to receive treatment for phony injuries
arrow It’s illegal for doctors, medical facilities, chiropractors, etc. to overbill for treatments, or to bill for treatments not provided.
arrow It’s illegal for people to stage car accidents to bilk or cheat insurance companies.
arrow These are all violations of the Health Care Claims Fraud Act.
Automobile Insurance
arrow It’s illegal to make or sell a fake motor vehicle insurance card.
arrow This is a violation of N.J.S.A. 2C:21-2.1a.
arrow Punishable by up to 18 months in jail and a $10,000 fine. Also, a person convicted is required to perform 30 days of community service.

 

 

 

 

To find out more about automobile insurance and coverage options go to NJ Department of Banking and Insurance – Shopping for Automobile Insurance in NJ Web site

Health Care Claims Fraud
arrow 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.
arrow 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.
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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.
arrow 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.
Insurance Applications
arrow It’s illegal to make or sell a fake motor vehicle insurance card.
arrow So if you don’t live in New Jersey…don’t try to insure your car here!
arrow It’s illegal to make an oral or written statement which is false or misleading in order to obtain insurance (such as home, health, life or automobile insurance).
arrow So tell the truth to your insurance agent and on your application!
arrow Licensed professionals who violate the insurance laws, from electricians to lawyers, may lose their State licenses!
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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.
arrow In addition to possible criminal penalties, a person violating the insurance laws may be required to pay a civil penalty of up to $5,000 N.J.S.A. 17:33A-5.

 

Medicaid Fraud
arrow 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.
arrow It’s illegal to over bill Medicaid for services provided.
arrow It’s illegal to receive more Medicaid benefits than you’re entitled to.
arrow These are violations of N.J.S.A. 30:4D-17.
arrow Punishable by up to 3 years in prison and a $10,000 penalty.
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They may also be violations of the Health Care Claims Fraud Act and other criminal statutes.
  Visit the Medicaid Fraud Control Unit Web site
Disability Benefits
arrow It’s illegal to receive these benefits if you are not disabled and can really perform the functions of your job.
arrow To do so is considered theft.
Unemployment Insurance Fraud
arrow It’s illegal to collect unemployment benefits while you are working.
arrow This is theft from the State unemployment insurance fund.
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If you steal over $500 you can go to jail for 3 to 5 years and be required to pay a fine of up to $15,000. Theft of more than $200 is punishable by up to 18 months in jail and a $10,000 fine. Theft of $75,000 or more is a second degree crime, punishable by 5 to 10 years in prison and a $150,000 fine.
Worker's Compensation
arrow It’s illegal for an employer not to purchase workers’ compensation insurance.
arrow Failure to purchase workers’ compensation insurance violates N.J.S.A. 34:15-79.

Various Fraud Scenarios

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