The Insurance Fraud Prevention Act (IFPA) was designed to prevent people from defrauding insurers by submitting insurance claims containing materially false information. In the healthcare context, a clear cut example of such prohibited conduct would be a physician who submits a health insurance claim form to a carrier for medical services he or she knows were never rendered. The IFPA allows private parties, including insurance carriers, to sue healthcare providers for violations of the statute. Notably, the statute expressly provides that insurance carriers may seek, in addition to damages, “reasonable investigation expenses, costs of suit and attorney fees.”
In an effort to claw back insurance moneys paid to providers – especially Personal Injury Protection (PIP) reimbursement dollars – carriers have continued to push the limits of the IFPA, often filing IFPA lawsuits based on nothing more than regulatory violations. To illustrate, a carrier might make the following argument: “Dr. Jones” maintains an unlawful practice structure by allowing a non-physician to hold a silent ownership interest in the practice, in violation of certain Board Medical Examiners’ (BME) regulations. Because Dr. Jones knew that he was in violation of BME regulations when submitting PIP claims to Carrier but did not disclose the BME violations to Carrier, Dr. Jones knowingly submitted a fraudulent claim in violation of the IFPA. Carrier lawsuits that rely on such argumentation – predicating fraud on arguably unrelated regulatory violations – contain weaknesses that can, in many instances, be successfully capitalized on by an experienced healthcare attorney.
In recent years, New Jersey PIP carriers such as Allstate and CURE have become increasingly aggressive in their filing of IFPA-based suits against healthcare providers. Frier Levitt is experienced in defending against IFPA actions. If you or your practice has been hit with one of these suits, contact Frier Levitt today to speak to one of our attorneys.
