In Bucks County, allegations of insurance fraud are investigated by the Office of the District Attorney. Several years ago, the county received funding that allowed for a detective and prosecutor to be retained specifically for this purpose. They work in conjunction with the Pennsylvania State Insurance Commission to investigate potential fraud in homeowners, auto, medical, and other types of insurance.
A recent survey among residents of Pennsylvania found that at least 70% of people would not even consider committing an act of insurance fraud. Unfortunately, that still leaves several million individuals that may consider such opportunities. The problem is increasingly prevalent, as there were roughly 524 cases in 2016 and 520 in 2017 across the state.
What is Insurance Fraud?
Pennsylvania statute (§4117) outlines many acts that constitute insurance fraud. One key element is that the crime is committed knowingly or with intent. It may involve presenting “false, incomplete, or misleading” information that may influence an insurance rate filing, act, or response. It may involve an act that seeks to defraud an insurer when making a claim. This may include inflating the number of actual losses associated with a claim. Often the crime is demonstrated by engaging in “unlicensed agent, broker, or unauthorized insurer” acts.
It may be committed by someone associated with a healthcare provider or organization to fraudulently receive reimbursement. An individual may use someone else's identity to file a fraudulent insurance claim. Those who are involved in some intentional activity that seeks to derive financial gain through civil actions such as claims of personal injury or wrongful death.
Additional Offenses
There are various acts that are related to insurance fraud that may be committed by healthcare providers or attorneys. Common actions include those involved with offering compensation in exchange for referrals. Another example would be providing personal patient information, such as those who have particular illnesses or conditions, in order to derive some benefit.
Most Common Specific Examples
- Staging or faking a vehicle accident
- Staging a fire or act of theft
- Making a false medical or disability-related claim
- Scams associated with rental insurance
Grading and Penalties
Depending on the nature of the circumstances, an insurance fraud offense may be charged as either a third-degree felony or a first-degree misdemeanor. Those convicted may be ordered to make restitution in addition to the penalties associated with the criminal offense. Insurers that are victims of fraud may pursue damages through civil action also.
|
Offense Level |
Maximum Imprisonment |
Maximum Fine |
|
Third-Degree Felony |
7 years |
$15,000 |
|
First-Degree Misdemeanor |
5 years |
$10,000 |
Pennsylvania Defense Attorney for Allegations of Fraud
Crimes such as insurance fraud are often deemed to be “white collar” types of offenses. These offenses create losses that are viewed as having an indirect adverse impact on all consumers, such as through increasing the costs of insurance. As a result, those prosecuting these matters tend to aggressively seek to prove allegations and impose harsh penalties on those convicted.
Our Criminal Law Team understands the potential ramifications of being convicted of a crime such as insurance fraud. We thoroughly investigate the facts and evidence involved in these matters in order to create a solid defense strategy. To discuss your legal options please contact the office today at 888-535-3686.
