Insurance fraud is the act of filing false claims to health, life, property, workers’ compensation, automobile or any other type of claim. Insurance fraud is categorized as criminal activity and is therefore regulated by both the federal and state laws. The laws that regulate insurance fraud are meant to protect both insurance companies and consumers from any fraudulent activities.
Insurance fraud is also categorized as either hard or soft. Cases of hard insurance fraud involve a thoughtful plan to claim an insurable loss, for instance, theft, car accident, or fire to get compensated by the insurance company for the supposed loss.
Soft insurance fraud is also referred to as opportunity fraud, and it involves the exaggeration of a legitimate claim by a policyholder to get a higher compensation. For instance, a person involved in a car accident can claim for serious injuries than they sustained. This is often meant to claim for a larger settlement. Misrepresentation of other preexisting conditions when purchasing an insurance policy to obtain a policy that would normally be declined or to receive a larger payout later is also considered as soft insurance fraud.
Federal and state laws outlaw both hard and soft insurance fraud. Because insurance fraud is one of the most favorable schemes of organized crimes, it has been criminalized. Each state in the U.S now classifies cases of insurance fraud as criminal activities. The federal government has also put in place laws that criminalize insurance fraud and created sentences for those who participate in schemes that result in either death or injury to other human beings.
Insurance fraud has become a big problem today, and that is why 41 states have created insurance fraud bureaus to fight illegal insurance activities. These bureaus are law enforcement agencies that have been given the jurisdiction of investigating any suspicious insurance fraudulent insurance claims.
Insurance fraud is often punishable depending on the value of the claims obtained or attempted to be reimbursed from an insurance company. In case you attempt to defraud an insurance company for property worth less than $300, this is regarded as a Class A offense and it is punishable by having to pay a fine of $2,500 or imprisonment of not less than one year. Defrauding an insurance company for property worth between $300 and $10,000 is classified as a Class 3 crime and is punishable by paying a fine of $25,000 and a jail term of two years minimum and a maximum of five years. If the insurance fraud exceeds an amount of $100,000, it is then considered as a Class 1 felony. These are serious crimes and are punishable by paying a fine of not less than $25,000 and a jail term of not less than four years and not exceeding fifteen years.
You should keep in mind that with any felony or misdemeanor conviction, the conviction will go on your record which is visible to schools, employers, military institutions, employers, and others. This means that a felony or misdemeanor conviction will have serious effects on your employment future.
You should never take an insurance fraud charge lightly. There are several channels to defend you if you are charged with such crimes. However, the type of defense you choose will mostly depend on your case. Some of the potential defenses that are used on insurance fraud charges include:
The absence of intent– You will only be charged for engaging in fraudulent activities if you knowingly obtain insurance reimbursements dishonestly. This means that if you unknowingly filed for insurance claims, you won’t be convicted.
Insufficient evidence– The prosecutor in charge of your case has the responsibility of proving all aspects of the fraudulent crimes committed. Therefore, if your attorney can prove reasonable doubt in the case by providing crucial evidence missing in your case, you won’t be convicted.
Lack of fraud– It is not always that statements provided can lead to a fraud case. This means that merely expressing yourself when filing for insurance claims should not always be regarded as fraudulent. For your charges to be dropped, your attorney will have to prove that the allegedly deceptive claim isn’t based on a fraudulent intent.
Your criminal defense lawyer will begin by reviewing the circumstances surrounding your insurance fraud case and create a strong defense with the information gathered. Your attorney may attempt to fight the charges during the early stages to prove lack of sufficient evidence and have your case dismissed. However, in some other cases, your attorney may try and negotiate for minimal sentence and a lower charge if you plead guilty. If your case proceeds to trial, your attorney will produce exculpatory evidence that can help you get exonerated.
It is advisable that you pursue legal assistance immediately after you are charged with insurance fraud to enable your attorney to gather evidence and mount an effective defense on your case during the early days. The decision you make during such a time may mean the difference between the dismissal of your case or prison time and hefty fines.
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If an insurance company or law enforcement agency has recently accused you of committing insurance fraud, you must respond right away so that you can protect yourself, your future and your reputation from irreversible damage. Judges and prosecutors take these charges seriously and will do everything in their power to bring you to justice. The worst part is that they can even target innocent people who have made honest mistakes.
No matter if you are a medical professional or a policyholder, you could face allegations when you least expect it. Moving forward without help is unwise and will probably destroy your chance of reaching a fair outcome. When you want to keep yourself out of harm’s way, turn to a trusted insurance fraud defense attorney as soon as you can. Doing so will reduce your odds of being convicted and provide you with the best possible results.
Insurance Fraud Defined
You will need to learn as much as you can about insurance fraud and how it works, which will give you a better understanding of the charges you are facing. Insurance fraud is the process of lying on an insurance claim to collect benefits to which you would otherwise not have access. In cases of soft fraud, patients will exaggerate the nature or impact of a legitimate claim to increase the amount of compensation they can collect.
Hard fraud occurs when people invent claims or stage accidents so that they can collect compensation, and this type is much easier for insurance companies and law enforcement to detect and prosecute. If you work in the medical field, law enforcement agencies can accuse you of filing a claim for services that you did not provide. Insurance fraud also covers cases in which medical professionals overcharge or lie about the type of treatment that they offered. If you are under investigation and don’t want to face unneeded problems, ask an insurance fraud lawyer for advice on what you should do next.
Insurance Fraud Penalties
When they are first accused of committing insurance fraud, most people ask about the type of penalties they could face if they lose in court, which is understandable. Prosecutors will usually seek a misdemeanor conviction when they suspect that someone has committed soft fraud, and you can face up to one year in jail and a fine of up to $15,000. If you commit hard fraud or are a medical expert and commit billing fraud, you will likely face felony charges, steep fines and up to five years in prison.
How Your Case Will Likely Progress
At this point, you might want to know how your case will move forward so that you can prepare yourself for the future. Fraud cases normally begin when an insurance company detects red flags that trigger an internal investigation. The insurance company will look into your past claims to detect a pattern of unusual behavior, but it can also conduct an audit and utilize private investigators. Since it does not want to give you time to cover your tracks, the insurance company is unlikely to notify you of the investigation at this point.
If your insurance company believes that it has enough evidence to pursue charges, it will hand the case over to a relevant law enforcement agency. Depending on what evidence they use against you, the police can obtain an arrest warrant and place you in jail. If you can afford your bail, you can get out from behind bars until the conclusion of your case. Your case will likely end with a plea deal if you are like other defendants. You can take your case to court if you are not pleased with the deal offered by the prosecution, and a jury will decide your fate.
How You Can Defend Yourself
When you are at risk for going to prison and being forced to pay fines, you must put in the effort to learn about your possible defenses. You can earn a verdict of not guilty if you can prove that the evidence against you is false, but that is only one approach. Since nobody is perfect, the errors on your claim could be the result of an honest mistake. Your insurance fraud attorney will look at the details of your case and help you form an effective defense.
How an Insurance Fraud Attorney Can Help
When you are facing insurance fraud allegations and enlist the support and guidance of a criminal defense attorney, your legal expert will learn about your case, review the evidence and help you understand the situation. Your attorney will tell you about the possible outcomes and what you can do to protect yourself and reduce the damage. A qualified and caring lawyer will search for holes in the prosecutor’s case to create reasonable doubt.
When you have a fraud defense attorney on your side, you will gain a fair deal from the prosecutor’s office, but you will also have the opportunity to challenge the accusations if you are not happy with the terms. If you decide to fight, your attorney will defend your name, reputation and future in front of a judge and jury.
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