Criminal charges were filed against 60 people across Pennsylvania in a two-month span in 2018 resulting from investigations by the Attorney General's Insurance Fraud Section. This was part of sweep lead by Attorney General Josh Shapiro, who vows to “aggressively prosecute” these cases. According to the Coalition Against Insurance Fraud, losses from insurance fraud across the country total roughly $80 billion annually.
The Insurance Information Institute reports that fraud in the property-casualty sector each year totals roughly $34 billion. Results of a recent survey conducted as part of a public campaign suggested that merely 23% of respondents could define insurance fraud. Approximately 32% of these individuals said they would report fraudulent activity.
Understanding Insurance Fraud
Insurance fraud can be broadly defined as when someone intentionally steals or otherwise engages in acts for their benefit by “scamming” an organization. The crime may involve submitting untruthful information to an insurer in an attempt to obtain something that they value. The crime is ordinarily a felony offense of the third degree that is punishable by up to seven years in prison and up to a $15,000 fine.
Examples of Automobile Insurance Fraud
- Staging a vehicle collision in order to receive insurance compensation
- Falsely claiming to have been injured in an accident
- Falsely claiming that your vehicle has been stolen
Examples of Health Insurance Fraud
- A patient creates a forged receipt for medical treatment and submits an insurance claim for reimbursement
- A medical provider billing an insurance company for a more costly medical procedure than what was provided
- A medical provider ordering and billing an insurance company for unnecessary tests, procedures, etc.
Examples of Homeowners Insurance Fraud
- Intentionally causing a fire at their home (arson) and filing the claim as accidental
- Falsely inflating the actual value of items stolen in a burglary in an insurance claim
- A homeowner who colludes with a contractor in defrauding an insurer
Workers Compensation Insurance Fraud in Pennsylvania (§1039.2)
Fraud associated with workers compensation are acts that are done intentionally or knowingly. One example is presenting or filing fabricated, incomplete, or deceptive information that impacts the approval or disapproval of an insurance rate filing or transaction. Fraud may involve filing any statements to support a workers compensation claim containing fabricated, incomplete, or deceptive information. It may involve participating in fraudulent activities as an unlicensed broker or agent.
A party may commit this crime when they knowingly benefit from proceeds derived through fraudulence. This may apply to a party associated with a healthcare-related facility that allows their premises to be used to conduct fraudulent activities. It may involve an individual making false statements regarding benefit eligibility to discourage an injured worker from obtaining benefits. Someone may submit false information to lower the amount to be paid in premiums. Workers may commit fraud by earning wages elsewhere while receiving total disability benefits.
Lawyer for Defending Allegations of Fraud in Pennsylvania
Are you the subject of an investigation or been charged with committing an act of insurance fraud? In these instances, it is critical to seek assistance from an attorney that is familiar with this realm of legal practice. Our Criminal Law Team will provide aggressive representation for clients by employing a comprehensive approach to your defense. For a case evaluation, contact the office at 888-535-3686 today.
