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Under 18 U.S.C. ยง 1347, certain types of Insurance Fraud are punishable by imprisonment of up to 10 years and up to 20 years if the fraud causes bodily injury.
According to the Federal Bureau of Investigation (FBI), insurance fraud costs insurance companies more than $40 billion each year. This does not include health insurance fraud, which by some estimates doubles the total cost to insurers. Unfortunately, these costs ultimately get passed on to premium-paying policyholders.
Equally unfortunate, in their efforts to combat insurance fraud, insurance companies and government investigators often get overzealous in accusing individuals and businesses of fraudulent conduct. The insurance companies have every incentive to deny claims, and they have teams whose sole job is to challenge claims on the basis of fraudulent conduct. When an insurance company alleges fraud, it can deny the policyholder’s claim, retroactively cancel their coverage, seek civil penalties, and then turn the case over for criminal prosecution.
At the The Criminal Defense Firm, we help our clients level the playing field. Our sole aim is on doing whatever it takes to have the charges against our clients dismissed. If you are facing criminal charges for insurance fraud, let us put our experience, dedication, and aggressive approach to criminal defense to work for you.
Put our highly experienced team on your side
Brian J. Kuester
Former U.S. Attorney
Former DA
Amanda Marshall
Former U.S. Attorney
Local Counsel
Joe Brown
Former U.S. Attorney
& Former District Attorney
Local Counsel
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Linda Julin McNamara
Former Chief, DOJ Appeals
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
Insurance Fraud Explained
Applicants and Policyholders
Most insurance fraud claims are brought against applicants and policyholders. In these cases, insurance fraud involves providing false information to an insurance company or intentionally damaging property in order to receive payments that are not properly owed. Minor offenses may be charged as misdemeanors; however, serious fraud crimes may be charged as felonies.
Insurance Agents and Insurance Companies
We also represent insurance agents and insurance companies that have been accused of insurance fraud. We handle cases involving:
- Embezzlement of insurance premiums (premium diversion)
- Use of “reinsurance agreements” to deplete policyholders premiums (fee churning)
- Theft of insurance company assets (asset diversion)
- Fraudulent denial of policyholders claims
Contractors
Contractors can face charges of insurance fraud as well. Some of the most common situations involve accusations of bid rigging and requiring up-front payment and then failing to perform the contracted repairs.
Health care fraud is a concern of epidemic proportions in the United States. From Medicare fraud to schemes by practitioners to overbill patient’s insurance companies, health care fraud encompasses a wide range of costly and illegal practices. Our attorneys have vast experience representing both individuals and corporate clients accused of health care fraud nationwide.
Defending Against Insurance Fraud Claims
In order to obtain a conviction for insurance fraud, the prosecution must prove beyond a reasonable doubt that you (i) made a false statement, (ii) knew the statement was false, and (iii) made the statement in connection with a claim or payment under an insurance policy. The government must also prove that your false statement caused the insurance company to make a payment it otherwise wouldn’t have on a claim.
In defending clients against allegations of insurance fraud, we seek to attack each individual element of the prosecution’s case. We will raise questions about the inaccuracy of your statements. Even assuming your statements were inaccurate, we will challenge that you knew it at the time they were made. We can also call into question whether the insurance company relied on your statements, or if they would have paid (or been obligated to pay) even in the absence of the alleged fraud.
Of course, each case is different, and the facts in your case may dictate a specific approach. But, generally speaking, these are some of the primary defenses to insurance fraud charges under state and federal law.
Penalties for Insurance Fraud Charges
Charges for felony insurance fraud can carry penalties of up to 10 years in federal prison and up to 20 years in cases involving bodily injury. Some of the most common charges involve:
- Making false statements on an insurance application
- Faking accidents or injuries
- Exaggerating the extent of an accident or injury
- Filing a false theft report
- Misclassifying the cause of damage in order to obtain coverage
- Arson
- Other methods of intentional destruction of property
Read more about facing investigations and defending allegations of health care fraud.
Schedule Your Free Insurance Fraud Case Evaluation
Our experienced criminal defense lawyers and former federal prosecutors provide vigorous and experienced representation for clients accused of insurance fraud. If you are under investigation or facing state or federal charges, we can help you protect your assets, your family, and your future. To schedule a free case evaluation, call 866-603-4540 or contact The Criminal Defense Firm online today.
The Criminal Defense Firm represents clients nationwide.