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John D. Fanburg is a partner in Brach, Eichle Rosenberg, Silver; Bernstein, Hammer Gladstone, a Roseland law firm. He specializes in health-care law, representing medical staff and medical practices. He also deals with health-care related fraud. Fanberg is counsel to a number of organizations, including Saint Barnabas Health Care System in Livingston.
BUSINESS NEWS: How prevalent is health-care fraud?
Fanburg: I think it's a huge problem, both in the federal reimbursement area and the private area. It is a problem with indemnity insurance and in HMO reimbursement for fee-for-service. We also see quite a bit of fraud in auto insurance under PIP claims.
BUSINESS NEWS: Can you give some examples of the types of fraud of which your clients might be accused?
Fanburg: Here's one example. Physicians in New Jersey are prohibited from referring patients to places where the physicians have an ownership interest. Self-referral transactions promote over-utilization. But since the law was passed in 1991, clever physicians, consultants and attorneys have come up with ways to get around it.
BUSINESS NEWS: Do you have numbers to quantify the amount of fraud taking place in New Jersey? Fanburg: None that are reliable. On the federal level, they say that 20c to 30 per dollar is fraud. It's not clear if it's due to deliberate overuse or just inefficiency.
BUSINESS NEWS: In recent years physicians have complained that if...