Recently 18 former NBA players were charged in a $4 million insurance fraud scheme involving fraudulent medical claims. Clearly even individuals with every advantage are tempted to commit insurance fraud.

Experts assert that insurance fraud is responsible for the theft of about $80 billion every year. Some of this is medical insurance fraud, some is property-casualty fraud.

Yet it’s completely possible to be falsely accused of insurance fraud. In 2019 Buzzfeed ran a report indicating that insurance companies were paying cops to “investigate” their own customers because it was cheaper for them to accuse customers of fraud than to pay claims in good faith. 

What is insurance fraud?

Insurance fraud is committed when someone makes a false statement to their insurer for financial gain. They are knowingly attempting to deceive the insurer to get a payout. Not only does this void your right to receive benefits from the insurer but it also could open you up to criminal charges.

Obviously being accused of insurance fraud is a serious matter, and it’s going to be imperative that you get the help of an experienced criminal lawyer with a solid background defending white collar crimes.

The most common form of fraud is exaggerating an estimate, filing a claim beyond the value of the property that the claim was filed for. 

Is insurance fraud a felony or a misdemeanor?

It depends on the amount of the claim. Fourth degree insurance fraud is more than $1000 but less than $3,000. First degree insurance fraud is anything more than one million dollars.

First degree insurance fraud is punishable by up to 25 years in a state prison. Fourth degree insurance fraud is punishable by up to four years in prison. 

Defending Against Insurance Fraud Charges

There are generally three defenses a lawyer can use to get you acquitted of insurance fraud, or to get the charges dropped or dismissed.

The first is a lack of intent. The prosecution must prove that you intended to commit insurance fraud.

The second is to show that you did not give fraudulent information, you merely offered a mistake of fact. If you didn’t know that you were giving inaccurate information you can’t be held accountable for giving inaccurate information.

The third is that the facts of the case 100% support everything you said in your insurance claim and we can prove it.

We can sometimes also mounts a partial defense. In this case, we might be able to reduce the severity of an insurance fraud claim by showing that you were trying to defraud the company out of a smaller amount than they’re claiming because the claim was mostly legitimate. Unfortunately this will not allow you to get any coverage for a denied insurance claim.

Have you been accused of insurance fraud?

You need to hire an attorney as soon as you know there’s trouble and you need to provide your attorney with everything you know about the case. You also need to avoid speaking to anyone else about your case without a lawyer present, even if that person is a family member or a friend.

If you’re in trouble, don’t wait. Contact Koch Law today to get the help that you deserve.

See also:

Are You Guilty of Loan Fraud?

Can a Bank Error Get You Accused of Fraud?

What to Do If You’re Accused of PPP Loan Fraud