Pennsylvania law values the concept of good faith and fair dealings. This concept serves as the backbone for most insurance laws in the state. Insurance fraud, a pervasive white-collar crime, threatens this foundation. Insurance fraud results in families paying hundreds of dollars in increased premiums through economic loss. This adds up to billions of dollars lost annually. Thus, lawmakers have created a legal framework to punish those accused of insurance fraud severely.
Insurance fraud is so costly that the Office of the Pennsylvania Attorney General has a dedicated Insurance Fraud Section. The Section has expansive powers to investigate and prosecute individuals and corporations alike. A single accusation of insurance fraud can thrust you into a nightmare of scrutiny, evidence collection, and courtroom battles. Those convicted face up to 7 years in prison and $15,000 in fines. That does not include civil penalties such as restitution and asset forfeiture, which can cost hundreds of thousands of dollars. Obtaining an experienced criminal defense attorney who can challenge the evidence and advocate on your behalf is often the only way to get a realistic chance in court.
If you find yourself under investigation by the Insurance Fraud Section, you need to take swift action. Retaining the LLF Law Firm equips you with skilled attorneys who grasp the nuances of state-specific laws. We have the experience to counter the prosecution's case. We stand ready to understand the allegations, challenge the evidence, and pursue every avenue to mitigate penalties, get a fair plea deal, or secure a dismissal. It's too dangerous to defend yourself alone. Contact the LLF Law Firm and our Criminal Defense Team at 888.535.3686, or you can fill out our online contact form today.
Insurance Fraud Laws in Pennsylvania
Pennsylvania law zeroes in on those who knowingly, with the intent to defraud, submit false or misleading information to insurers, state or local government agencies, or individuals. This means that insurance fraud is broadly defined and can encompass a wide variety of acts. The definition of insurance fraud encompasses various domains, from auto claims to health care schemes.
Depending on the exact type of insurance fraud, it may be prosecuted as either a third-degree felony or a first-degree misdemeanor. Some of the most common types of insurance fraud include:
- Automobile Insurance Fraud: This includes a wide variety of fraud relating to automobiles. Examples include staged accidents, where a driver hits another driver and then planted witnesses say that the victim caused the accident. Other examples include inflating the cost of a car repair or a tow, falsely reporting a car as stolen, or knowingly including old damage in a new claim.
- Homeowners Insurance Fraud: Examples include falsely reporting the condition of the home to get lower premiums, exaggerating damages from adverse weather to get a higher payout, and intentionally destroying the home and claiming it was an accident in a claim.
- Health Care Fraud: Health care fraud can include submitting claims for durable medical equipment (such as wheelchairs or walkers) that are not necessary, staging accidents and fabricating injuries to a health insurance provider, or submitting claims for unnecessary tests, exams, treatments, or medications.
- Application Fraud: This type of fraud covers the act of knowingly providing false information on an insurance application. Examples include covering up health conditions or previous claims on a health insurance application or misrepresenting how a property is going to be used.
The Authority for Enforcing Pennsylvania Insurance Fraud Laws
The Pennsylvania Office of Attorney General's Insurance Fraud Section is the primary authority for enforcing insurance fraud laws in the state. Launched in 1996, this unit has the power to probe and prosecute insurance fraud across the entire state. From large cities like Philadelphia and Pittsburgh to mid-sized cities such as Reading, Erie, and Scranton to rural counties throughout the state, the Insurance Fraud Section strictly prosecutes alleged cases of insurance fraud.
Insurers, too, play a role. Large insurance groups often have investigative units that actively feed tips and data to law enforcement. If you're accused of insurance fraud in Pennsylvania, you're not just facing a small-time local prosecutor. Instead, you're up against a well-oiled machine that partners with private and state actors to ruthlessly prosecute and convict.
The Consequences of Insurance Fraud Convictions
Almost all convictions of insurance fraud are punished as a third-degree felony. Offenses associated with insurance fraud may be charged as a first-degree misdemeanor. A third-degree felony conviction can land someone with up to seven years in prison and a $15,000 fine. A first-degree misdemeanor can result in up to five years in prison and a $10,000 fine.
The consequences do not stop there. Courts can order those convicted to repay every cent defrauded in restitution, plus investigative costs. In civil court, victims can sue to recover triple the amount defrauded and for attorney fees.
Still, the consequences do not stop. A criminal record can follow you for the rest of your life. Professional licenses, from medical credentials to legal certifications, are likely to be suspended if not outright revoked. The Insurance Fraud Section routinely reports convictions to disciplinary boards, ensuring your punishment goes far beyond the courtroom.
Insurance Fraud Investigations in Pennsylvania
When the Pennsylvania Office of Attorney General's Insurance Fraud Section detects potential fraud, its investigative machinery kicks into high gear. All it takes to start an investigation is a single tip from an insurer or a whistleblower. The Section's investigators move quickly, sifting through financial records, interviewing witnesses, and analyzing surveillance footage. Their effort is methodical, and the investigation can take months or even years to complete.
Their reach is broadened through collaboration. Pennsylvania's Insurance Fraud Prevention Authority provides critical resources. Insurers routinely report suspicious invoices, applications, and other documents. Undercover operations, like agents posing as claimants to test a provider's integrity, are not uncommon.
For those under scrutiny, the experience can be overwhelming. The Section routinely demands access to records and testimony. They try to interview you, your employers, your friends, and your family. Additionally, they may apply for search warrants to enter your home or place of business. This can traumatize your children or your employees and co-workers in an instant.
The section takes its time. Their goal is to create an airtight case. They want you to feel that you cannot escape and the only way out is to admit your guilt. If you find yourself entangled in this process, staying silent until you have legal representation is the best course. The LLF Law Firm understands the prosecutors' strategies and stands ready to challenge warrants, suppress evidence, or dismantle their case before it fully takes shape.
The Legal Process After Being Charged With Insurance Fraud
Once charged, you enter the criminal process. It begins with an arraignment where you enter an initial plea. Preliminary hearings follow, examining the strength of evidence. Here, the Insurance Fraud Section gives the basis of their claims. It may include witness statements, forged documents, etc. An attorney from the LLF Law Firm can file motions to dismiss flimsy claims or suppress illegally obtained evidence.
Discovery unfolds next, a phase where both sides exchange evidence. Prosecutors might bury you in paperwork, making legal representation critical. Our team can counter with subpoenas to uncover errors or witness bias.
Our lawyers also engage with prosecutors at pre-trial conferences hashing out plea deals or the logistics of a trial. If the evidence is strong, a skilled white-collar criminal defense attorney can help you obtain a favorable plea deal. If not, the attorneys at the LLF Law Firm are prepared to fight for you in court.
Trials can be long and grueling processes. Much of it involves cross-examining expert witnesses hired by the prosecution. An experienced criminal defense attorney can poke holes in the expert's theories and counter with expert witnesses of their own. If an accused goes to trial without an attorney, their odds of a favorable outcome are almost impossible.
If the trial results in an unfavorable outcome, the attorneys at the LLF Law Firm have extensive experience filing appeals with the Superior Court of Pennsylvania and even all the way to the Supreme Court of Pennsylvania. Criminal appeals analyze the trial for misapplications of the law and procedural errors. They are not a “do-over,” although they can order a new trial. Because appeals are highly technical and often deal purely with interpretations of the law, retaining the LLF Law Firm is paramount to winning your appeal.
Retain the LLF Law Firm to Begin your Defense
Insurance fraud charges in Pennsylvania are serious accusations. The Office of the Attorney General's Insurance Fraud Section has expansive investigatory power and will not rest until those accused are behind bars. If you do not have a strong defense, you can spend years in prison and have your finances ruined for life.
You don't have to face this fight alone. Don't wait as the evidence mounts and prosecutors try to threaten you into admitting your guilt. Our team can help get evidence suppressed, charges dismissed, and favorable plea deals entered. Contact the LLF Law Firm at 888.535.3686 or tell us about your case online today.
