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What Is Insurance Fraud?

Insurance fraud is a broad category of criminal offense that can be perpetrated by claimants as well as the insurance policymakers themselves. Insurance agents or firms may, themselves, be complicit in fraud such as by refusing legal, lawful coverage claims by deception or unwillingness to pay.

What Are Some Common Types of Insurance Fraud?

Health care fraud, automobile accident fraud, property insurance fraud and personal injury fraud, as well as workers’ compensation fraud, are common categories of insurance fraud, although many others exist.

Health care fraud takes place when, for example, a doctor or other specialist bills a patient — or their insurer — for treatments that either did not take place whatsoever or were completely unnecessary. This practice is commonly referred to as “padding” a bill.

Auto insurance fraud can occur in situations where an accident is “staged” in order to cause damage to both vehicles, writing them off. Beyond this, healthcare fraud can also get involved, as personal injury claims can be the result of a vehicular accident.

In a similar scenario, property insurance fraud can take place if a property owner pays an individual to destroy an undesirable or unprofitable property via arson or some other means to gain a payout from the insurer.

Is Insurance Fraud Always Classified As a Felony?

Insurance fraud is most commonly classified as a felony — particularly when charged at the federal level, rather than at the state level — but there are instances in which insurance fraud can be charged as a misdemeanor.

In some states, for example, health care fraud is classified as a Class A misdemeanor unless accompanied by aggravated insurance fraud charges (meaning that the accused has participated in three separate instances of fraudulent behavior in the past 18 months). More generally, in other states, insurance fraud is classified as a misdemeanor if the amount defrauded from the insurer is less than $300. For amounts over $300, it is a felony charge (either Class 3 or Class 1).

Other states hold a similar legal categorization concerning health insurance fraud. Any healthcare fraud involving a sum defrauded of $950 or less is classified as a felony, while a sum defrauded of $950 or more is instead a felony.

Can You Go to Jail for Insurance Fraud in California?

Those convicted of insurance fraud can face a jail term or a prison sentence. If you are being charged at the state level, and if you are being charged with a misdemeanor rather than a felony, it may be possible for your defense attorney to negotiate with the prosecution to avoid time in jail.

What Is the Penalty for Insurance Fraud?

Those convicted of insurance fraud at the federal level could face a penalty of up to 10 years. That penalty is generally enhanced to a maximum of 15 years if the insurer is placed into a financially precarious situation such as liquidation, rehabilitation or conservation.

At the state level, insurance fraud penalties vary. In instances of misdemeanor charges, a conviction could result in a penalty of up to one year in county jail as well as a fine. In situations involving more serious felony charges, a maximum of 15 years in prison could be the end result.

Monetary fines or restitution can also be a common penalty in response to an insurance fraud conviction. Such financial penalties also typically take the form of double — or in some cases, treble — damages. This means if you defrauded an insurer for $25,000, it is possible that (if convicted) you could be faced with $50,000 in fines in addition to any incarceration needing to be served.

Are You Accused of Insurance Fraud?

Committing fraud against insurance firms, such as making a false claim, is a serious criminal offense carrying long terms of confinement in state or federal prison. Insurance companies can be very sophisticated in recognizing and investigating fraudulent actions and generally prosecute these cases.

Insurance Fraud Legal Recourse

If you are facing criminal charges for fraud, you should immediately consult a defense lawyer who handles insurance fraud cases. The lawyer can explain your options and protect your constitutional rights. Your lawyer will investigate the alleged facts, challenge evidence and aggressively handle your defense. Your lawyer may also negotiate a plea agreement.

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