Pennsylvania's Insurance Fraud Prevention Authority is at the forefront of efforts to combat fraud. In 2018, the organization received more than 3,900 complaints of potential fraud. More than 400 individuals were prosecuted as a result of their work. Defendants across the state were ordered to pay restitution that exceeded $5.6 million.
Here in Lancaster County, the Controller's Office established a Fraud, Waste, and Abuse Hotline that allows residents to confidentially report fraud. The following chart outlines some recent data:
|
2016 |
2017 |
2018 |
|
|
Fraud Referrals |
2,880 |
3,719 |
3,978 |
|
Arrests |
490 |
426 |
467 |
Acts of Insurance Fraud
Insurance fraud generally occurs when someone knowingly steals or otherwise participates in acts for their benefit that “scams” an insurance company. Often this is committed by submitting deceptive information to an insurer in an attempt to obtain something of value.
Common Automobile Insurance Fraud Schemes
- “Creating” a vehicle accident
- Falsely reporting injuries in an accident or “inflating” the severity of injuries incurred
- A false claim that an insured vehicle was stolen
Common Homeowner Insurance Fraud Schemes
- Creating a fire (arson) at an insured property such as a home or place of business
- “Inflating” the value of items that were stolen to boost an insurance claim
- Colluding with a repair contractor to defraud an insurer
Common Health Insurance Fraud Schemes
- A patient submits phony receipts for reimbursement of medical services or treatments that were not performed
- A healthcare provider intentionally bills the patient's insurance company for a more costly procedure than was performed
- A healthcare provider orders unnecessary tests or lab work to file an insurance claim for reimbursement
Grading and Penalties for Felony Offenses
The majority of insurance fraud cases are charged as third-degree felony offenses. A convicted offender may face up to seven years in prison and a fine of up to $15,000. Offenders are also likely to be ordered to pay restitution to the victim and may be placed on a period of community supervision (probation).
Grading and Penalties for Misdemeanor Offense
Some offenders may have their cases charged as a first-degree misdemeanor offense. The maximum penalties that may be imposed are up to five years of incarceration and a fine of $10,000. Insurance fraud cases are only charged as misdemeanors under the following circumstances:
- Certain acts that involve a lawyer who pays or provides something of value in exchange for referrals or employment
- If a health care provider pays or provides something of value in exchange for referrals or employment
- A lawyer or health care provider provides names and contact information of individuals who are likely to need legal or medical services
- Those who provide false information or conceal information on an application to obtain insurance coverage
Attorney for Defense of Allegations of Insurance Fraud in Pennsylvania
Have you been the subject of an investigation or recently been charged with acts of insurance fraud? It is important to seek help from a lawyer that is very familiar with this area of legal practice. Our Criminal Law Team provides aggressive representation for clients by creating a strategic plan of defense. For a complimentary case evaluation, contact our office at (888) 535-3686 today.
