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New Jersey Insurance Fraud Whistleblower Program
If you’re aware of systemic fraud upon a commercial insurance provider in New Jersey you should speak with a New Jersey Insurance Fraud Whistleblower law firm like Brown, LLC to understand your rights about whether you can blow the whistle. Presently, if insurance fraud also implicates systemic fraud against Medicare and/or Medicaid you can file a case under the Federal False Claims Act – a statute that nets hundreds of millions of dollars each year in whistleblower awards.
Under the present New Jersey whistleblower statute (NJCEPA), if you’re an insider and aware of systemic fraud upon an insurance company, your rights as whistleblower are protected; however, there’s presently no mechanism for you to receive a percentage of the recovery from the fraud. Other states (California, Illinois and to a lesser extent New York) have enacted state whistleblower statutes that enable the insider to receive a percentage of what the insurance companies recover and it’s possible that New Jersey will eventually follow suit.
To learn your rights about how to become a whistleblower in New Jersey and to blow the whistle on systemic insurance fraud you should consult with an experienced whistleblower law firm like Brown, LLC.
Examples of systemic insurance fraud
- Routinely billing an insurance company for services that were not performed, or for a higher level of service than what was provided (“upcoding”).
- Pharmaceutical reps paying kickbacks to doctors to get them to prescribe certain drugs.
- Engaging “cappers” or “runners” to recruit patients or clients.
Penalties for Insurance Fraud in New Jersey
Entities that defraud private insurance companies in New Jersey could face penalties and fines, both civil and criminal. The specific penalties and fines will depend on the nature and severity of the fraud. However, New Jersey state law currently does not provide a mechanism to obtain a reward for blowing the whistle on fraud upon private insurers.
Whistleblower Rewards for Reporting Insurance Fraud in New Jersey
If a New Jersey whistleblower program were to be established that resembles other state programs, a whistleblower could secretly bring suit against the defrauding party in the name of the State and file a complaint under seal. Such a suit is known as a qui tam lawsuit. The government would then investigate the allegations.
The California whistleblower statue provides that someone who successfully blows the whistle on private insurance fraud can receive between 30% and 40% of the recovered amount if the State intervenes in the case. In a non-intervened case, the successful whistleblower could receive between 40% and 50% of the proceeds. Hopefully, New Jersey will pattern a New Jersey Insurance Fraud Prevention Whistleblower statute after the California statute. However, at present New Jersey does not allow qui tam lawsuits for fraud upon private, commercial insurers, but Brown, LLC may still go over your options with you with a free, confidential whistleblower consultation.
Protection for Whistleblowers in New Jersey
New Jersey law already protects individuals who blow the whistle or report unethical or illegal conduct under NJCEPA; however, it’s critical to blow the whistle the right way to make sure you are properly invoking the statutory protections. If a New Jersey qui tam whistleblower program were to be established like the ones in Illinois and California, employees who suffer retaliation for reporting fraud upon commercial insurance companies could enjoy additional protections.
A Qui Tam Provision for Private Insurance Fraud Would Benefit New Jersey
Insurance fraud harms all of us, and a New Jersey Insurance Fraud Whistleblower Program could incentivize whistleblowers, which would help cut down on insurance fraud and thus lower premiums in the long term. Moreover, it’s one thing to fraudulently bill for services not rendered which is economic fraud and insurance fraud, but it’s another thing entirely to actually perform unnecessary services that put the patient at risk, just for the sake of billing – for example, “fixing” or even removing teeth that are healthy, or even performing medically unnecessary surgeries. A statute that encouraged whistleblower lawsuits for fraud upon private insurers would help stop such practices.
Contacting a New Jersey Insurance Fraud Whistleblower Lawyer
To be absolutely clear – if you’re aware of systemic fraud upon New Jersey Medicaid or any other program of the state government, you may be entitled to an award for blowing the whistle. But presently, if you’re aware of fraud upon a commercial insurer in New Jersey, state law does not presently provide a mechanism for a whistleblower award, but you should speak with a whistleblower law firm to go over your options.
To find out more about the possibility of a New Jersey Insurance Fraud Whistleblower Program, speak with an experienced whistleblower law firm like Brown, LLC.