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What is Insurance Fraud?

In Florida, insurance fraud is considered a serious crime and is punishable by jail time. Because so much is at stake, it is important for those who are being investigated for or have been charged with insurance fraud to speak with an experienced white collar crime attorney who may be able to get their charges reduced or even dismissed.

Defining Insurance Fraud

According to state law, a person can be convicted of insurance fraud if he or she had the intent to injure or deceive an insurer and presented a written or oral statement in support of a claim, knowing that the statement contained false or misleading information. What constitutes a statement is defined broadly and so could include:

  • Notices;
  • Proof of loss;
  • Bills of lading;
  • Invoices;
  • Accounts;
  • Bills for services;
  • Diagnoses;
  • Prescription records;
  • Hospital or doctor records;
  • X-rays and other test results;
  • Estimates of property damage; and
  • Any evidence demonstrating loss, expense, or injury.

However, a person can also be charged with committing insurance fraud if he or she:

  • Prepares a statement with the intent to file a false claim;
  • Includes incomplete or misleading information on an insurance application;
  • Knowingly conceals information regarding any material fact on an application;
  • Systematically assigns inaccurate billing codes to obtain reimbursement;
  • Filing a claim under a personal injury protection insurance policy if he or she knows that the payee submitted a fraudulent application when applying for licensure as a health care clinic. These prohibitions also apply to insurers, including their agents and representatives.

These prohibitions also apply to insurers, including their agents and representatives.

Types of Fraud

Some of the most common insurance fraud schemes include:

  • Inflating actual claims;
  • Submitting claims for injuries that were never sustained; and
  • Staging accidents.

There are two main types of insurance fraud, which are referred to as hard fraud and soft fraud. Hard fraud involves a deliberate attempt to stage or invent an accident that is covered by someone’s insurance policy. Soft fraud, on the other hand, occurs when a claimant files a legitimate claim, but exaggerates the severity of his or her injuries.

How insurance fraud is charged depends largely on the amount of money allegedly involved in the offense. For instance, if the value of the property involved in an insurance fraud scheme is less than $20,000, the defendant can be charged with a third degree felony, which is punishable by up to five years in prison and a $5,000 fine. However, if the value exceeded $20,000, but was not more than $100,000, the charge will be a second degree felony, which carries the much harsher punishment of 15 years in prison and a $10,000 fine. Finally, crimes involving over $100,000 are considered first degree felonies, which are punishable by up to 30 years in prison and a $10,000 fine.

Defendants are often also required to compensate the plaintiffs for attorneys’ fees, pay compensatory damages, and pay substantial civil penalties.

Contact an Experienced White Collar Crime Attorney Today

If you are being investigated for insurance fraud, we may be able to help. Please contact Jeffrey S. Weiner, P.A. Criminal Defense Attorneys at (305) 670-9919 today to schedule a consultation. Our South Florida attorneys are eager to assist you today.


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