Insurance Fraud

Insurance fraud is a type of criminal act that involves intentionally deceiving or tricking an insurance carrier to obtain payment from the insurance company to which one is not legally entitled.

Insurance fraud could involve:

• Auto insurance.
• Health Insurance.
• Homeowner Insurance.
• Life Insurance.
• Property Insurance.
• Workers’ Compensation Insurance.
• Any other type of insurance which protects a person against damages, personal losses or other assets of value.

At The Ansara Law Firm, our Fort Lauderdale criminal defense lawyers know that most cases, insurance fraud is committed by those who are applying for insurance, those who hold policies and those making claims. Depending on the circumstances involved, insurance fraud could be pursued by either state or federal prosecutors. Depending on the severity of the situation, you could be facing anything from a sizable fine and probation to decades in prison.

Some of the unlawful acts that may constitute as insurance fraud include:

• Intentional destruction of property.
• Faking or staging a car accident.
• False injury claims.
• Theft/ misuse of state funds.
• Claiming Medicaid/ Medicare benefits for services either unnecessary or never received.
• Workers’ compensation premium avoidance/ diversion by employer.
• Operating an unauthorized insurance entity.
• Arson for profit.

In addition to criminal penalties, it is becoming increasingly common for insurance companies to pursue civil litigation per the RICO (Racketeering Influenced and Corrupt Organizations) Act. Defendants who lose these claims may be forced to pay substantial fines.

Insurance Fraud in Florida

Insurance fraud has proliferated in recent years, especially in Florida. The Coalition Against Insurance Fraud reports some of the reasons for that include:

• Low-risk crime. There are no guns. There is generally no roaming the streets. It’s a white-collar offense, and it’s often high-reward.
• Easy target health care systems. A growing number of medical providers have automated billing systems, and this can make it easy to conceal the validity of treatment claims.
• Insurers don’t fight back. While many insurers do fight fraud, some will still simply pay claims they find questionable because it’s less expensive than going to court.
• View it as a victimless crime. Insurance fraud can be reasoned away as a type of Robin Hood act, where the only individual hurt is the insurance company.

Florida’s Division of Investigative and Forensic Services reports it receives approximately 10,000 reports of fraud in the state every year. Some of those cases have included:

• Unlicensed insurance agent charged with 72 felony counts for stealing nearly $50,000 in escrow payments.
• Fort Lauderdale woman allegedly caught on camera faking injury.
• Fort Myers business owner steals more than $1 million through payroll check-cashing and workers’ compensation fraud.
• Food stamp trafficking scheme compromises 500 personal identities in Palm Beach County.
• Unlicensed South Florida clinic owners use straw owner to defraud insurers of more than $650,000.
• Broward chiropractor arrested for $1.5 million insurance fraud scam.
• Four PIP (personal injury protection) fraud co-conspirators arrested in Miami.

Florida reportedly ranks high nationally when it comes to:

• Number of referrals for insurance fraud investigations (No. 4).
• Number of insurance fraud cases presented for prosecution (No. 3).
• Number of arrests for insurance fraud cases (No. 2).
• Recovery of losses from insurance fraud through court-ordered restitution (No. 1.).

Insurance fraud in Florida can result in severe penalties, which is why it’s imperative for those facing charges to speak to an experienced Broward criminal defense attorney.

Florida Law on False and Fraudulent Insurance Claims

Florida lawmakers took a hardline with false and fraudulent insurance claims, as noted in F.S. 817.234.

The statute outlines the various types of fraud, from auto insurance fraud to health care fraud, and then spells out the penalties, which are predicated on the amount of money the offender allegedly swindled.

Per Section 11 of that statute, fraud that involves:

• Less than $20,000 is a third-degree felony, punishable by up to five years in prison.
• Between $20,000 and $99,999 is a second-degree felony, punishable by up to 15 years in prison.
• $100,000 or more is a first-degree felony, punishable by up to 30 years in prison.

On top of any criminal liability, a person convicted of committing insurance fraud may also face civil penalties that may include:

• Up to $5,000 for a first-time offense.
• Between $5,000 and $10,000 for a second-offense.
• Between $10,000 and $15,000 for a third-or subsequent offense.
• Between $15,000 and $50,000 for an intentional motor vehicle crash or a scheme to create documentation of a crash that did not exist for the purposes of filing a tort claim or filing for personal injury protection (PIP) benefits.

Those civil penalties are paid to the Insurance Regulatory Trust Fund, and does not insulate the convicted offender from additional civil action from the affected parties.

Contact Fort Lauderale criminal defense lawyers at The Ansara Law Firm by calling (954) 761-4011 or send us an email. We serve clients in Broward, Palm Beach and Miami-Dade Counties.