New Jersey § 2c:21-4

§ 2c:21-4.

a. A practitioner is guilty of a crime of the second degree if that person knowingly

commits health care claims fraud in the course of providing professional services. In addition to all other criminal penalties allowed by law, a person convicted under

this subsection may be subject to a fine of up to five times the pecuniary benefit

obtained or sought to be obtained. b. A practitioner is guilty of a crime of the third degree if that person recklessly

commits health care claims fraud in the course of providing professional services. In addition to all other criminal penalties allowed by law, a person convicted under

this subsection may be subject to a fine of up to five times the pecuniary benefit

obtained or sought to be obtained. c. A person, who is not a practitioner subject to the provisions of subsection a.

or b. of this section, is guilty of a crime of the third degree if that person knowingly

commits health care claims fraud. A person, who is not a practitioner subject to the provisions of subsection a. or

b. of this section, is guilty of a crime of the second degree if that person knowingly

commits five or more acts of health care claims fraud and the aggregate pecuniary

benefit obtained or sought to be obtained is at least $1,000. In addition to all other criminal penalties allowed by law, a person convicted under

this subsection may be subject to a fine of up to five times the pecuniary benefit

obtained or sought to be obtained. d. A person, who is not a practitioner subject to the provisions of subsection a.

or b. of this section, is guilty of a crime of the fourth degree if that person recklessly

commits health care claims fraud. In addition to all other criminal penalties allowed by law, a person convicted under

this subsection may be subject to a fine of up to five times the pecuniary benefit

obtained or sought to be obtained. e. Each act of health care claims fraud shall constitute an additional, separate and

distinct offense, except that five or more separate acts may be aggregated for the

purpose of establishing liability pursuant to subsection c. of this section. Multiple acts of health care claims fraud which are contained in a single record,

bill, claim, application, payment, affidavit, certification or other document shall

each constitute an additional, separate and distinct offense for purposes of this

section. f. (1) The falsity, fictitiousness, fraudulence or misleading nature of a statement

may be inferred by the trier of fact in the case of a practitioner who attempts to

submit, submits, causes to be submitted, or attempts to cause to be submitted, any

record, bill, claim or other document for treatment or procedure without the practitioner,

or an associate of the practitioner, having performed an assessment of the physical

or mental condition of the patient or client necessary to determine the appropriate

course of treatment. (2) The falsity, fictitiousness, fraudulence or misleading nature of a statement may

be inferred by the trier of fact in the case of a person who attempts to submit, submits,

causes to be submitted, or attempts to cause to be submitted any record, bill, claim

or other document for more treatments or procedures than can be performed during the

time in which the treatments or procedures were represented to have been performed. (3) Proof that a practitioner has signed or initialed a record, bill, claim or other

document gives rise to an inference that the practitioner has read and reviewed that

record, bill, claim or other document. g. In order to promote the uniform enforcement of this act, the Attorney General shall

develop health care claims fraud prosecution guidelines and disseminate them to the

county prosecutors within 120 days of the effective date of this act. h. For the purposes of this section, a person acts recklessly with respect to a material

element of an offense when he consciously disregards a substantial and unjustifiable

risk that the material element exists or will result from his conduct. The risk must be of such a nature and degree that, considering the nature and purpose

of the actor's conduct and the circumstances known to him, its disregard involves

a gross deviation from the standard of conduct that a reasonable person would observe

in the actor's situation. i. (1) Nothing in this act shall preclude an indictment and conviction for any other

offense defined by the laws of this State. (2) Nothing in this act shall preclude an assignment judge from dismissing a prosecution

of health care claims fraud if the assignment judge determines, pursuant to N.J.S.2C:2-11 , the conduct charged to be a de minimis infraction.