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Insurance Fraud

Insurance fraud is any effort to deceive or to distort insurance claims to obtain money that you would not otherwise be entitled. This goes for all types of insurance, including: health insurance, life insurance, business insurance, auto insurance and home owner’s insurance.

Under this broad term, we are including efforts to wrongfully take advantage of Social Security, Medicare, Medicaid and disability programs.

If you are facing insurance fraud charges, discuss your charges with a criminal defense attorney. Simply fill out the free case evaluation form on this page or call 877-445-1059 today.

What is Insurance ?

Insurance fraud may be perpetrated by insurance recipients or service providers, like doctors and mechanics. The goal for either group is to receive money for damages or service that did not occur.

Many methods are used to deceive insurance providers. Sometimes the efforts are simple, such as overstating the value of stolen property. Other times, there are complex schemes involved to fake car accidents or personal injuries.

In an attempt to pull off insurance fraud, individuals may engage in other crimes, such as arson, murder or identity theft.

For any of these programs, fraud may include any of the following actions:

  • Exaggerating claims and inflating damages
  • Deliberately causing damages
  • Staging false “accidents”
  • A service provider inflating bills
  • False bills
  • Staged or suspicious death

Types of Insurance Fraud

Car insurance fraud: Inflated claims are common in this area, but so are deliberate accidents.

These fraud schemes may involve a person deliberately crashing his car or more elaborate efforts like the “swoop and squat.” This involves a driver “swooping” in front of your car and slamming on the breaks in an attempt to initiate a collision. The “swooper” would then file insurance claims for damages.

Medical insurance fraud/health insurance fraud: This is one of the most common types of insurance fraud, and even doctors and pharmacies have been involved.

In most medical insurance fraud cases, there are false or exaggerated injuries. Sometimes, offenders will even stage accidents, such as slips and falls. Doctors and pharmacists, on the other hand, may be charged with fraud if they are found to be over-billing insurance companies, claiming higher cost for treatments or even charging for treatment that never occurred.

Life insurance fraud: This could involve attempts at faked death, policies taken out on behalf of non-existent persons and even murder.

Property insurance fraud: This includes a wide range of offenses, from arson in an attempt to claim fire insurance to staging a robbery. Inflated damages and exaggerated value for stolen property are common offenses.

If you have been charged with a crime, or think you may have committed insurance fraud, you may want to speak with a criminal defense attorney. To contact a lawyer near you, simply fill out the free case evaluation form on this page.

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Social Security Fraud

Social Security fraud cases are similar to insurance fraud. Social Security disability fraud cases, in particular, most often resemble health insurance fraud.

This type of fraud may be prosecuted differently because of the group being defrauded. Because Social Security is a government program, the fraud laws in your state may be slightly different.

Common activities that may be considered Social Security fraud include:

  • Continuing to work while receiving disability payments
  • Faking or exaggerating an injury to receive disability
  • Concealing income, assets or a marriage in an effort to keep or increase benefits
  • Receiving and cashing checks designated for the deceased
  • Receiving benefits for a child not under your care
  • False statements on a claim, including signing up for benefits under another identity

Medicare and Medicaid Fraud

Similarly, Medicare and Medicaid fraud cases often involve false or exaggerated claims.

Doctors may also commit Medicare fraud if they bill the program for services they did not render. If doctors bill for different treatments than they performed, such as billing for more expensive procedures, this could be considered fraud, too.

The other common avenues for Medicare and Medicaid fraud are:

  • Using another person’s Medicare or Medicaid card to receive benefits
  • Billing Medicare and Medicaid for household equipment that was returned
  • False statements on Medicare and Medicaid claims
  • Filling for Medicare and Medicaid benefits under another identity

Insurance Fraud Penalties

Insurance may be investigated by police, government agencies or the insurance companies themselves. Most insurance companies have divisions especially for investigating claims of fraud, and some states also have agencies whose sole job is to investigate suspected fraud.

The penalties for committing insurance fraud vary depending on the circumstances and the state where the crime occurred. Typically, the penalties correspond to the amount of money involved in the fraud.

Insurance fraud may be classified as a misdemeanor or a felony. Jail sentences of less than 10 years plus fines are common.

Doctors that participate in the crime may be punished more harshly.

In some states, social security and disability fraud may be categorized as a theft.

Fraud Charges? Contact a criminal defense attorney today!

If you are facing criminal charges, you may want to contact a criminal defense attorney. A lawyer can help guide you through the process of fighting your fraud charges.

A criminal defense lawyer can answer any questions you have about fraud law and how it affects your case. To contact a criminal defense lawyer near you, simply fill out our free online evaluation form on this page or call, toll free, 877-445-1059.

The above summary of insurance fraud is by no means all-inclusive and is not legal advice. Laws may have changed since our last update. For the latest information on insurance fraud laws and penalties, speak to a criminal defense attorney in your area.


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