Insurance Fraud

Insurance Fraud

The Insurance Fraud Unit is charged with the responsibility of investigating and prosecuting instances of insurance fraud, healthcare claims fraud, unlicensed practice of medicine, chiropractic, and dentistry, and commercial bribery. 

An insurance fraud is committed when an individual or business makes false or misleading statements of material fact in support of a claim against a policy of insurance. A healthcare claims fraud is committed when a healthcare provider, such as a medical doctor or chiropractor, submits a false or fraudulent claim for benefits to a healthcare plan. 

Health care claims fraud often involves instances of commercial bribery, where doctors refer patients to specialists not based upon disinterested professionalism but in exchange for illegal payments.

The Insurance Fraud Unit of the Passaic County Prosecutor’s Office investigates and prosecutes these fraudulent schemes that seek to divert insurance payments away from legitimate claimants and into the pockets of scammers. The Unit seeks to protect patients from exploitation from doctors who provide medically unnecessary treatment for the purpose of inflating billing. Since 2012 the Insurance Fraud Unit has prosecuted nine  unscrupulous medical doctors and chiropractors for healthcare claims fraud. 

The Unit investigates automobile accident schemes where claims are generated for Personal Injury Protection benefits for accident victims who are not injured. The Unit also investigates cases involving billing for medical services not rendered and billing for “upcoded” services, where billing is submitted for medical procedures more complex than those actually provided to the patient.

Other acts of insurance fraud, such as fraudulent homeowner’s claims and false theft claims are also investigated by the Unit. 

The Insurance Fraud Unit investigates unlicensed doctors and unlicensed dentists who fraudulently provide medical services without a license to practice in the State of New Jersey.

The Unit works closely with the Attorney General’s Office of Insurance Fraud Prosecutor, the Division of Consumer Affairs, the National Insurance Crime Bureau and the Special Investigation Units of the various insurance carriers.