New Jersey § 30:4d-17

§ 30:4d-17.

(a) Any person who willfully obtains benefits under P.L.1968, c. 413 ( C.30:4D-1 et seq. ) to which a person is not entitled or in a greater amount than that to which a person is entitled and any provider who willfully receives medical assistance payments to

which a provider is not entitled or in a greater amount than that to which a provider is entitled is guilty of a crime of the third degree, provided, however, that the

presumption of nonimprisonment set forth in subsection e. of N.J.S.2C:44-1 for persons who have not previously been convicted of an offense shall not apply

to a person who is convicted under the provisions of this subsection. (b) Any provider, or any person, firm, partnership, corporation , or entity, who: (1) Knowingly and willfully makes or causes to be made any false statement or representation

of a material fact in any cost study, claim form, or any document necessary to apply

for or receive any benefit or payment under P.L.1968, c. 413 ; or (2) At any time knowingly and willfully makes or causes to be made any false statement,

written or oral, of a material fact for use in determining rights to such benefit

or payment under P.L.1968, c. 413 ; or (3) Conceals or fails to disclose the occurrence of an event which (i) affects a person's initial or continued right to any such benefit or payment, or (ii) affects the initial or continued right to any such benefit or payment of any

provider or any person, firm, partnership, corporation , or other entity in whose behalf a person has applied for or is receiving such benefit or payment with an intent to fraudulently

secure benefits or payments not authorized under P.L.1968, c. 413 or in a greater amount than that which is authorized under P.L.1968, c. 413 ; or (4) Knowingly and willfully converts benefits or payments or any part thereof received

for the use and benefit of any provider or any person, firm, partnership, corporation , or other entity to a use other than the use and benefit of such provider or such

person, firm, partnership, corporation , or entity; is guilty of a crime of the third degree, provided, however, that the

presumption of nonimprisonment set forth in subsection e. of N.J.S.2C:44-1 for persons who have not previously been convicted of an offense shall not apply

to a person who is convicted under the provisions of this subsection. (c) Any provider, or any person, firm, partnership, corporation , or entity who solicits, offers, or receives any kickback, rebate , or bribe in connection with: (1) The furnishing of items or services for which payment is or may be made in whole

or in part under P.L.1968, c. 413 ; or (2) The furnishing of items or services whose cost is or may be reported in whole

or in part in order to obtain benefits or payments under P.L.1968, c. 413 ; or (3) The receipt of any benefit or payment under this act, is guilty of a crime of

the third degree, provided, however, that the presumption of nonimprisonment set forth

in subsection e. of N.J.S.2C:44-1 for persons who have not previously been convicted of an offense shall not apply

to a person who is convicted under the provisions of this subsection. This subsection shall not apply to (A) a discount or other reduction in price under P.L.1968, c. 413 if the reduction in price is properly disclosed and appropriately reflected in the

costs claimed or charges made under P.L.1968, c. 413 ; and (B) any amount paid by an employer to an employee who has a bona fide employment

relationship with such employer for employment in the provision of covered items or

services. (d) Whoever knowingly and willfully makes or causes to be made or induces or seeks

to induce the making of any false statement or representation of a material fact with

respect to the conditions or operations of any institution or facility in order that

such institution or facility may qualify either upon initial certification or recertification

as a hospital, skilled nursing facility, intermediate care facility, or health agency,

thereby entitling them to receive payments under P.L.1968, c. 413 , shall be guilty of a crime of the fourth degree. (e) Any person, firm, corporation, partnership, or other legal entity who violates

the provisions of any of the foregoing subsections of this section or any provisions

of section 3 of P.L.2007, c. 265 ( C.2A:32C-3 ), shall, in addition to any other penalties provided by law, be liable to civil penalties

of : (1) payment of interest on the amount of the excess benefits or payments at the

maximum legal rate in effect on the date the payment was made to said person, firm,

corporation, partnership or other legal entity for the period from the date upon which

payment was made to the date upon which repayment is made to the State ; (2) payment of an amount not to exceed three-fold the amount of such excess benefits

or payments ; and (3) payment in the sum of not less than and not more than the civil penalty

allowed under the federal False Claims Act ( 31 U.S.C. s.3729 et seq. ), as it may be adjusted for inflation pursuant to the Federal Civil Penalties Inflation

Adjustment Act of 1990, Pub.L.101-410 for each excessive claim for assistance, benefits or payments. (f) Any person, firm, corporation, partnership , or other legal entity, other than an individual recipient of medical services reimbursable

by the Division of Medical Assistance and Health Services, who, without intent to

violate P.L.1968, c. 413 , obtains medical assistance or other benefits or payments under P.L.1968, c. 413 in excess of the amount to which he is entitled, shall be liable to a civil penalty

of payment of interest on the amount of the excess benefits or payments at the maximum

legal rate in effect on the date the benefit or payment was made to said person, firm,

corporation, partnership, or other legal entity for the period from September 15,

1976 or the date upon which payment was made, whichever is later, to the date upon

which repayment is made to the State, provided, however, that no such person, firm,

corporation, partnership , or other legal entity shall be liable to such civil penalty when excess medical assistance

or other benefits or payments under this act are obtained by such person, firm, corporation,

partnership , or other legal entity as a result of error made by the Division of Medical Assistance

and Health Services, as determined by said division; provided, further, that if preliminary

notification of an overpayment is not given to a provider by the division within 180

days after completion of the field audit as defined by regulation, no interest shall

accrue during the period beginning 180 days after completion of the field audit and

ending on the date preliminary notification is given to the provider. (g) All interest and civil penalties provided for in P.L.1968, c. 413 and all medical assistance and other benefits to which a person, firm, corporation,

partnership, or other legal entity was not entitled 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. ), except that recovery actions against minors or incapacitated persons shall be initiated in a court of competent jurisdiction. (h) Upon the failure of any person, firm, corporation, partnership , or other legal entity to comply within 10 days after service of any order of the

director or the director's designee directing payment of any amount found to be due pursuant to subsection (g)

of this section, or at any time prior to any final agency adjudication not involving

a recipient or former recipient of benefits under P.L.1968, c. 413 , the director may issue a certificate to the clerk of the Superior Court that such

person, firm, corporation, partnership , or other legal entity is indebted to the State for the payment of the amount. A copy of such certificate shall be served upon the person, firm, corporation, partnership , or other legal entity against whom the order was entered. Thereupon the clerk shall immediately enter upon the record of docketed judgments the name of the person, firm, corporation, partnership , or other legal entity so indebted, and of the State, a designation of the statute

under which such amount is found to be due, the amount due, and the date of the certification. Such entry shall have the same force and effect as the entry of a docketed judgment

in the Superior Court. Such entry, however, shall be without prejudice to the right of appeal to the Appellate

Division of the Superior Court from the final order of the director or the director's designee. (i) In order to satisfy any recovery claim asserted against a provider under this

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

the division or its fiscal agents is authorized to withhold funds otherwise payable

under P.L.1968, c. 413 to the provider. (j) The Attorney General may, when requested by the commissioner or the commissioner's agent, apply ex parte to the Superior Court to compel any party to comply forthwith

with a subpoena issued under P.L.1968, c. 413 . Any party who, having been served with a subpoena issued pursuant to the provisions of P.L.1968, c. 413 , fails either to attend any hearing, or to appear or be examined, to answer any question

or to produce any books, records, accounts, papers or documents, shall be liable to

a penalty of $500 for each such failure, to be recovered in the name of the State in a summary civil

proceeding to be initiated in the Superior Court. The Attorney General shall prosecute the actions for the recovery of the penalty

prescribed in this section when requested to do so by the commissioner or the commissioner's agent and when, in the judgment of the Attorney General, the facts and law warrant

such prosecution. Such failure on the part of the party shall be punishable as contempt of court by

the court in the same manner as like failure is punishable in an action pending in

the court when the matter is brought before the court by motion filed by the Attorney

General and supported by affidavit stating the circumstances. (k) Notwithstanding the provisions of N.J.S.2C:43-3 to the contrary, but in addition to any other penalty or disposition that may be

imposed by law: (1) a person who violates the provisions of subsection (a), (b), or (c) of this section

shall be liable to a penalty of not less than $15,000 and not more than $25,000 for

each violation; and (2) a person who violates the provisions of subsection (d) of this section shall be

liable to a penalty of not less than $10,000 and not more than $25,000 for each violation. ( l ) A person who violates the provisions of subsection (a), (b), or (c) of this section

under circumstances in which the aggregate amount obtained or sought to be obtained

is $1,000 or more, who has previously been convicted of a violation of the provisions

of subsection (a), (b), or (c) of this section within 10 years of the current violation,

under circumstances where the aggregate amount obtained or sought to be obtained was

$1,000 or more, is guilty of a crime of the second degree and, in addition to any

other penalty or disposition authorized by law and notwithstanding the provisions

of N.J.S.2C:43-3 to the contrary, shall be liable to a penalty of not less than $25,000 and not more

than $150,000 for each such repeat violation.