Insurance Fraud

Making a false insurance claim is a crime. Fraud occurs when making false claims or misrepresentations to the insurance company. Insurance fraud can involve a single claim for benefits or be part of a larger criminal enterprise. The insurance companies are aggressive in pursuing fraud cases. This can lead to serious criminal charges and penalties.

The insurance company may deny your claim based on perceived fraud. If the insurance company reports fraud to the police, it can lead to state or federal charges. To understand your legal options, speak with an experienced insurance fraud criminal defense attorney.

What Is Insurance Fraud?

Insurance fraud doesn’t just include fraudulent claims by policyholders. It can also involve insurance companies, insurance agents, adjusters, healthcare providers, or business owners. Insurance fraud can happen at any point, from your application for coverage to making an insurance claim.

Many people think of insurance fraud as a victimless crime. The insurance industry takes millions of dollars in insurance premiums and puts up a fight anytime someone files a claim. Regardless of how you feel about the insurance companies, attempted fraud can be a criminal offense.

What Are Types of Insurance Fraud?

Insurance is involved in many parts of your life. This includes individual insurance policies and business insurance. Common types of insurance fraud include:

• Automobile insurance
• Health insurance
• Life insurance
• Homeowner insurance
• Workers’ compensation fraud
• Commercial property insurance
• Renter’s insurance

Committing Insurance Fraud

Committing insurance fraud could include attempts to get money on a claim or to collect from another person’s insurance company. This includes bodily injury claims for car accidents or personal injury claims against a property owner. Other scenarios may include:

• Providing false information on an insurance application
• Making a workers’ compensation claim for an injury that happened at home
• Making an insurance claim for loss or injury based on false statements
• Intentionally causing damage or loss to make an insurance claim

Health Care Fraud by Doctors

Insurance fraud can also involve doctors or healthcare professionals. There is a lot of bureaucracy and paperwork involved in health care benefits. An increased claim or billing for an unperformed medical service can easily go undetected.

Some fraud claims can go back for years and include hundreds of patients. Billing for service fraud may involve private health insurance, auto insurance, and federal government providers like Medicare fraud.

What Are the Criminal Penalties for Insurance Fraud?

An insurance fraud conviction can lead to harsh punishments. The insurance companies lobby lawmakers to ensure this type of fraud is taken very seriously. The criminal penalties for fraud depend on several factors, including:

• Amount of money involved
• Type of fraud committed
• The extent of the fraud
• The number of people involved
• Victims of fraud
• Criminal history

Insurance fraud can be a misdemeanor or felony. As a misdemeanor, fraud is generally punishable by a fine, restitution, and jail time for up to a year. As a felony, a conviction could result in a lengthy prison stay. Felony offenses also have collateral consequences that could limit your ability to find a job, own a firearm, or serve on a jury.

Attorney Defense Strategies to Criminal Fraud Charges

There are common defense strategies for criminal insurance fraud charges. Talk to your lawyer about the criminal defense options for your case, which may include:

• An unintentional mistake on a claim or insurance form
• Lack of evidence
• Another person committed fraud in your name
• Law enforcement conducted an illegal search

Do I Need a Lawyer if I’m Under Investigation by the Insurance Company?

Many insurance fraud cases begin with an investigation by the insurance company. The insurer looks for red flags or suspicious claims indicating potential fraud. Red flags and fraud warnings may involve you:

• Making a claim just after getting insurance coverage
• Asking hypothetical questions about claims before filing a similar claim
• Being deep in debt
• Having a history of similar claims
• Pushing for a quick settlement

Unfortunately, insurance companies may question legitimate claims. They can deny your insurance claim and report you for fraud. As soon as you learn about an investigation for a fraudulent insurance claim, consider talking to a lawyer. Plenty of innocent people have gone to jail after being accused of insurance fraud. Contact an attorney with experience in insurance fraud defense and other white-collar crimes.