Employee Liability for Company’s Insurance Fraud
When an employer asks an employee to commit insurance fraud, the latter cannot escape the criminal or civil consequences just because the plan was not his or her own. Even if the company is held liable for the primary penalties of committing insurance fraud, the employee who actually engaged in the activities could still face jail time and fines, so if you were instructed by an employer to commit insurance fraud and are now being investigated, it is critical to retain an experienced white collar crime attorney who can ensure that your rights and interests are protected.
Types of Insurance Fraud
Although there are a number of ways to commit insurance fraud, at the core of most cases is a claim of material misrepresentation, or a false statement made in order to collect a benefit under a policy. This could take any of the following forms:
- Making a false statement to deny benefits to an employee or prevent that individual from filing a claim;
- Present a false or misleading statement concerning compliance with state or federal insurance reporting requirements;
- Misrepresent or conceal payroll, classification of employees, or information regarding an employer’s loss history;
- Making a false statement to deny insurance coverage to a policyholder; or
- Billing insurers for healthcare services that were not rendered.
All of these actions violate state law, and in some cases, federal law, even if an employee only committed them after being instructed to by an employer.
Consequences of Conviction
While employers who instruct their employees to commit insurance fraud might take the brunt of the court’s ire, the employee will still most likely face charges for his or her individual actions and participation in the scheme. This is because state law specifically requires employees to report their employers if they have knowledge of or believe that a fraudulent act is being committed by their company. Those who fail to report this conduct and instead assist someone else, including an employer, in engaging in insurance fraud face felony charges.
However, a person can only be convicted of insurance fraud if the prosecutor can prove that the defendant knowingly made a false or misleading statement that:
- Was made in connection with an insurance claim or payment; and
- Was material, in that it could impact the outcome of the claim.
Finally, in addition to criminal penalties, an employee could face civil charges if the case is also filed in civil court. In these cases, the wronged party could sue both the company and the individual employee separately for the same offense.
Schedule a Free Case Evaluation
To set up a free consultation with a dedicated white collar crime attorney who can help defend you against allegations of insurance fraud, please call Jeffrey S. Weiner, P.A., Criminal Defense Attorneys in Miami at 305-670-9919 or complete one of our brief online contact forms. With more than 44 years of experience, our firm is well-equipped to formulate strong defenses on our clients’ behalf. Please contact a dedicated member of our legal team today to learn more about how we can help you.