Insurance fraud involves providing false or inaccurate information to an insurance company for purposes of unlawfully obtaining something of value. The crime is generally charged as a felony offense in Pennsylvania. Those who are convicted often face incarceration, significant fines, and other penalties.
The Lehigh County District Attorney's Office is the local agency that is responsible for investigating insurance fraud in both Northampton and Lehigh County. This is one of 11 agencies across the state that receives critical funding for this purpose.
Types of Insurance Fraud Committed in Pennsylvania in 2018[1]
|
Auto |
Homeowners |
Workers Comp |
Health |
Commercial |
Life |
Other |
|
57% |
13% |
10% |
9% |
7% |
2% |
2% |
Pennsylvania Insurance Fraud (§4117)
Insurance fraud may be committed in various ways and involve any of the different types of insurance coverage. There are some commonalities associated with the offense. A key element required is that the act of fraud is committed with intent. Often the offense is committed by multiple individuals who conspire with one another.
Policyholders may commit the crime by falsely increasing the actual value of insured items that were lost, stolen or damaged. Fraud does occur in all realms of the insurance market including automobile, homeowners, health, and workers compensation.
|
Level of Offense |
Maximum Period of Imprisonment |
Maximum Fine |
|
First-Degree Misdemeanor |
5 years |
$10,000 |
|
Third-Degree Felony |
7 years |
$15,000 |
Health Insurance Fraud
This type of fraudulent activity may be committed by either the patient (policyholder) or a medical provider. A healthcare provider may order a patient to undergo tests or lab work that is not needed to submit an insurance claim. A provider may bill a patient's insurance for a more costly medical procedure than what was performed. Providers may engage in “kickback” schemes to compensate a third-party for generating patient referrals.
Automobile Insurance Fraud
An insured driver may “stage” an accident and submit an insurance claim or falsely report that their vehicle was stolen. Someone involved in a vehicle collision may falsely claim to have been injured or “exaggerate” the true severity of injuries incurred in a collision.
Homeowner Insurance Fraud
An insured homeowner may intentionally set fire to their property. Someone may falsely file an insurance claim for some property they say was stolen. A property owner may conspire with a repair contractor to “inflate” the actual costs of necessary repair services.
How Will a Defense Attorney Help My Case?
In addition to a potential jail sentence and significant fines, having a felony conviction may create long-term challenges. A background check is commonly used by employers that are considering a new hire, by landlords for prospective tenants, and by various agencies responsible for professional licensing. Your attorney will look for opportunities to challenge the evidence, ensure that your rights were protected in the investigation and arrest, and consider other ways to aid your defense.
Pennsylvania Attorney Defends Cases of Insurance Fraud
Our Criminal Law Team are seasoned criminal defense lawyers that represent clients in the Northampton County region. We will analyze the specific circumstances and evidence involved as part of a comprehensive defense strategy. For a case evaluation, call (888) 535-3686 today.
[1] https://www.helpstopfraud.org/IFPA_2018Report-Final2.pdf
