Newark Health Care Fraud Lawyer

Newark Health Care Fraud Attorney

You might think an accusation of health care fraud leads to paying fines or required reporting, but these allegations can have dire consequences, from jail time to total destruction of your reputation. Newark health care fraud cases are highly technical, and even honest paperwork mistakes can lead to criminal charges. A Newark health care fraud lawyer is essential to protecting your business and your freedom.

At Tim Anderson Law, we fight for our clients when investigators, auditors, or insurers question your actions. As a respected New Jersey criminal defense attorney and law firm, we understand federal and state regulations, real-world documentation procedures, and courtroom-tested strategies. Our goal is not only clarity, but to safeguard your future.

What Is Health Care Fraud?

Health care costs are enormous, which is one reason fraud investigations have risen. According to data from the American Medical Association, U.S. health care spending reached $4.9 trillion in 2023.

In New Jersey, health care fraud is defined as knowingly submitting false or misleading medical bills, medical claims, or treatment records for payment. This applies to medical providers as well as anyone filing a claim. Health care fraud in New Jersey can result in serious criminal charges and significant financial penalties, depending on the amount of money involved.

According to the FBI, common examples of health care fraud involve:

• Billing for services not provided
• Charging for higher-level services than those given
• Misrepresenting medical necessity
• Falsifying records or certificates
• Paying or receiving kickbacks

If you are under a health care fraud investigation or believe an investigation is coming, speak with an attorney today to take control of any inquiries and protect your reputation.

Types of Health Care Fraud Charges in Newark

Health care fraud cases are investigated nationwide, including in New Jersey. Data from the United States Sentencing Commission revealed that 395 health care fraud cases were reported in the 2024 fiscal year.

These cases include billing disputes, misrepresentation of services, and improper claims. These were submitted to Medicare, Medicaid, or private insurers by both health care providers and recipients.

Common charges against health care providers include:

• Billing for unperformed services
• Falsifying diagnostic codes
• Accepting kickbacks or referral payments

Common charges against health care recipients include:

• Misrepresenting eligibility
• Using another person’s insurance
• Submitting false claims for reimbursement

Contact an experienced Newark health care fraud attorney as soon as you receive notice of an audit or subpoena. Taking action early and quickly protects your reputation and your rights.

Consequences of Health Care Fraud in Newark

The risk of penalties for health care fraud laws is significant and should be taken seriously. In 2024, the Justice Department reported that 193 defendants were responsible for $2.75 billion in intended losses. Defendants included doctors, nurse practitioners, and other medical practitioners across the country.

Consequences of health care fraud often include:

• Fines
• Restitution
• Criminal charges
• Loss of professional licensing
• Imprisonment

A Newark health care fraud attorney can help you navigate these financial, professional, and legal consequences. At Tim Anderson Law, we provide proactive strategy, a complete review of billing data, and experienced courtroom representation.

When government agencies escalate allegations, your first step is to hire a Newark health care fraud lawyer. Our firm understands both local investigations and the federal system.

Why You Should Hire a Health Care Fraud Lawyer in Newark

When health care fraud allegations arise, things move fast. They often involve many people, like insurers, auditors, and federal investigators and prosecutors. An experienced Newark health care fraud attorney knows the evidence standards that prosecutors must meet. They can challenge assumptions before charges are finalized and the damage is done.

With over 30 years of defending complex white-collar cases across New Jersey and other states, Tim Anderson Law brings a high level of federal criminal defense experience to every health care fraud investigation. Our firm represents physicians, providers, and business owners at every stage from early inquiry to trial.

Our clients receive strategic, meticulous defense grounded in professionalism and proven results. Tim Anderson Law is trusted when the stakes are highest. If you are worried about health care fraud allegations, do not hesitate to call our office today.

FAQs

What Is Upcoding?

Upcoding is when a health care provider bills for a more expensive medical service than what was actually provided. For example, a routine office visit would be coded as an emergency-level consultation. Upcoding is illegal and inflates the costs charged to Medicare, Medicaid, or private insurers. If investigators suspect you of upcoding, contact a Newark health care fraud attorney to help defend against such allegations, such as showing that potential clerical mistakes were not intentional.

How Hard Is it to Prove Medicaid Fraud?

How hard it is to prove Medicaid fraud depends on available documentation, billing patterns, and whether the government can show intent. Prosecutors must prove that someone knowingly submitted false claims or misrepresented facts to obtain payment. Many cases start from billing irregularities and not criminal motives. A Newark health care fraud lawyer evaluates whether charges are based on a misunderstanding or inaccurate assumptions.

What Are the Five Federal Laws for Health Care Fraud and Abuse?

The five federal laws for health care fraud and abuse are usually considered the False Claims Act, the Anti-Kickback Statute, the Stark Law, the Federal Health Care Fraud Statute, and the Civil Monetary Penalties statutes. Each regulates different forms of misconduct. Since these laws overlap and involve federal prosecution, working with a Newark health care fraud attorney ensures you are protected throughout the investigation and any court proceedings.

Can You Go to Jail for Health Insurance Fraud?

Yes, you can go to jail for health insurance fraud. Health insurance fraud can result in jail or prison time when prosecutors believe the conduct was intentional, involved false claims, or caused significant financial losses. Other penalties include restitution, fines, and professional licensing consequences. When you hire a health care fraud lawyer in Newark, you challenge the assumptions and reduce exposure to serious consequences.

Contact Tim Anderson Law Today

Health care fraud allegations can threaten your career, your freedom, and your future, which is why you need experienced legal counsel rooted in New Jersey’s federal and state systems. With more than 30 years of defending complex white-collar cases, Tim Anderson and his team provide strategic, meticulous advocacy from the earliest stages of investigation through trial.

If you are facing health care fraud concerns in Newark and across New Jersey and the metro area, contact us today to protect your rights and reputation.