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Insurance Fraud

When we think about insurance fraud, the first thing that comes to mind is automobiles, where someone falsely claims that another party damaged their car in a collision so they can collect insurance money. While this is indeed a frequently seen form of insurance fraud, there are other types that have one thing in common: the alleged perpetrator filed a fraudulent claim to seek the compensation they are not entitled to. In addition, there are also times where  the actual insurance companies and their agents commit fraud in their dealings with clients.

Automobile insurance fraud

Automobile insurers lose billions of dollars a year due to fraudulent claims. Examples include:

  • Reporting a car stolen when it was actually left in a high-risk neighborhood or deliberately destroyed to collect insurance money.
  • Claiming that the car was damaged in an accident when it wasn’t.
  • Trying to get compensation that was unrelated to a legitimate accident. For example, the vehicle owner might file a claim for a window broken weeks earlier.

In New York, there are five degrees of insurance fraud. Which one applies in a particular case will depend on how much money was illegally obtained. Insurance Fraud in the Fifth Degree is a Class A misdemeanor, while Insurance Fraud in the First Degree is a Class B felony that can send you to prison for up to 25 years.

Health insurance fraud

Both patients and care providers can be found criminally responsible for health insurance fraud.   In the former situation, the patient might lie about their income or family situation to receive insurance or to get a lower premium or seek medical care using someone else’s insurance, while the latter may perform fraudulent acts such as:

  • Performing unnecessary procedures in order to bill for them.
  • Billing for medical services that were never provided.
  • Billing for multiple insurance codes for services that should be billed under a single combination code (a scam known as unbundling).

If the fraud involves government programs such as Medicare or Medicaid, then federal authorities usually get involved. Penalties can include a fine of up to $10,000 for making false claims to obtain service payments, and up to 10 years in prison for trying to defraud a health care program. Providers suspected of committing health care fraud may also have their assets seized.

Life insurance fraud

Life insurance fraud costs the industry hundreds of millions of dollars every year. It can take many forms, the most sensational of which includes killing someone to collect insurance benefits, faking a death, and purchasing a policy for a nonexistent person in order to claim death benefits. Other types, which can be committed by either insurance agents or policyholders, include:

  • Making misleading statements to sell a pricier policy that has not offered better coverage
  • Stealing premiums submitted by policyholders
  • Selling annuities at inflated prices

Although most insurance fraud cases are prosecuted by state authorities (Medicare and Medicaid fraud are noted exceptions), you can still face federal charges if you used the U.S. mail, radio, television, and even the Internet to perpetrate the scheme. If found guilty, then you could face decades of imprisonment.

If you are accused of insurance fraud, then let your next call be to New York criminal defense attorney Julie Rendelman at 212-951-1232. When your future is at stake, experienced legal guidance and counsel give you the best chance at ensuring your freedom. With more than 20 years of legal experience, Ms. Rendelman is well-versed in the law and will fight for your rights.

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The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create an attorney-client relationship and receipt or viewing does not constitute such relationship.


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