New Jersey § 26:2h-18

§ 26:2h-18.

a. Any person or entity who makes a false statement or misrepresentation of a material

fact in order to qualify any person or entity for any benefits to which he is not

entitled under this act or P.L.1996, c. 28 ( C.26:2H-18.59e et al.), shall , in addition to any other penalty to which the person or entity may be subject under

law, be liable to civil penalties of: (1) payment of interest on the amount of the excess benefits or subsidy payments at

the maximum legal rate in effect on the date the benefits were provided to the person

or payment was made to the person or entity, for the period from the date upon which

benefits were provided or payment was made to the date upon which repayment is made

to the department; and (2) payment of an amount not to exceed three times the amount of the excess benefit

or subsidy payment. b. A hospital which, without intent to violate this act, obtains a subsidy payment

in excess of the amount to which it is entitled, shall be liable to a civil penalty

of payment of interest on the amount of the excess payment at the maximum legal rate

in effect on the date the payment was made to the hospital, from the date upon which

payment was made to the date upon which repayment is made to the department, except

that a hospital shall not be liable to the civil penalty when an excess subsidy payment

is obtained by the hospital as a result of an error made by the department, as determined

by the commissioner. c. All interest and civil penalties provided for in this section shall be recovered

in an administrative proceeding held pursuant to the “Administrative Procedure Act,”

P.L.1968, c. 410 ( C.52:14B-1 et seq. ). d. In order to satisfy any recovery claim asserted against a hospital under this section,

whether or not that claim has been the subject of final agency adjudication, the commissioner

is authorized to withhold subsidy payments otherwise payable under this act to the

hospital. e. A person who is seeking health care services at a hospital as a patient for a non-emergency

or elective procedure who does not furnish proof of health insurance coverage for

the services or eligibility for charity care or reduced charge charity care in accordance

with the provisions of section 10 of P.L.1992, c. 160 ( C.26:2H-18.60 ), or for any other program of benefits funded by the State, shall be required to

provide sworn financial information sufficient to determine eligibility for any such

program of benefits. Notwithstanding any other provision of law to the contrary, if the person does not

provide the required financial information or the hospital determines that the person

is ineligible for any of the aforementioned benefits, the hospital shall be entitled

to conclude an arrangement with the person, or an individual acting on the person's

behalf, to receive payment from or on behalf of that person as a condition of the

provision of health care services to that person. For the purposes of this subsection, “ non-emergency or elective procedure ” means a procedure to treat a condition that is not an “emergency” as defined in N.J.A.C.8:38-1.2 . f. Commencing one year after the effective date of P.L.2007, c. 217 ( C.26:2H-18.60a et al.) and notwithstanding the provisions of any other statute or regulation to

the contrary, a hospital that receives a subsidy payment pursuant to P.L.1992, c. 160 ( C.26:2H-18.51 et al.), on the basis of a charity care claim that the hospital had reasonable cause

to suspect was fraudulent as determined by the commissioner, shall, in addition to

any other penalty to which the hospital may be subject under law, be subject to a

reduction of $2 in the distribution of charity care subsidy payments that it receives

during the next succeeding fiscal year for each $1 of subsidy payment received by

the hospital on the basis of the fraudulent claim. If the hospital complied with the regulations and procedures established by the department

with respect to charity care documentation, the claims shall be deemed to be presumptively

non-fraudulent unless the commissioner determines that the hospital knew or should

have known that the information submitted was inaccurate. g. In any year in which the Legislature and Governor reuses a base year for the calculation

of charity care reimbursement, notwithstanding the provisions of section 3 of P.L.2004, c. 113 ( C. 26:2H-18.59i ) to the contrary, a hospital subject to a penalty under subsection f. of this section

for that base year shall not be subject to the penalty for the same fraudulent claims

in the subsequent year when the base year is reused.