How to Defend Against Criminal Insurance Fraud

Hurricane Sandy fraud, Covid-19 fraud, and health care fraud—just to name a few.

“With the possible exception of murder and drug abuse, no serious crime attracts as wide a variety of perpetrators as insurance fraud,” states the New Jersey Office of the Insurance Fraud Prosecutor’s website. “People who would never think of robbing a bank, stealing a car, or burglarizing a home can find the temptations of ‘easy money’ from insurance fraud hard to resist.”

According to the Federal Bureau of Investigation, insurance fraud costs the average family between $400 and $700 per year in increased premiums. And, because the crime has such far-reaching impacts, New Jersey’s insurance defense laws are among the strictest in the nation, with false insurance claims in the state routinely investigated and aggressively prosecuted.

Whether you are a medical professional, a person running a business, or a person who submitted an insurance claim on a personal insurance policy, if you have been charged with insurance fraud or are under investigation for alleged insurance fraud, it’s imperative that you contact an attorney right away to begin building a strong insurance fraud defense—even if you do not believe you did anything illegal.

Criminal insurance fraud in New Jersey defined

New Jersey’s penal code defines criminal insurance fraud as intentionally providing false information or withholding relevant information from an insurance company for personal gain.

Insurance fraud can take many forms, but they all have one thing in common: they’re crimes with serious consequences.

Common types of criminal insurance fraud

Healthcare fraud

Medical insurance fraud, also known as healthcare fraud, involves making untrue statements to receive payment for health-related services. Many kinds of healthcare workers may be accused of this crime, including doctors, chiropractors, nurses, medical assistants, and other professionals.

Experts estimate that healthcare fraud costs the nation up to $300 billion each year. To mitigate the loss, both the Office of the United States Attorney in New Jersey and the Office of the Attorney General in New Jersey aggressively prosecute healthcare fraud.

One of the strategies our team of lawyers utilizes is early intervention with government agencies and retaining industry experts in the medical field to convince them that questioned billing was appropriate and not a criminal act. Additionally, in some circumstances, it may be the case that accidental billing errors should be remediated through a civil action, as opposed to being prosecuted as healthcare fraud.

In addition, even if you were not aware of the fraudulent intentions at the time, you can still face criminal charges for healthcare fraud, including conspiracy, if you followed a supervisor’s instructions to:

Provide unnecessary medications or treatments to patients
Bill for medications and treatments that weren’t administered
Upcode a patient’s condition to charge an insurance company more money for treatment

Other types of healthcare fraud

Healthcare workers are not the only people who commit healthcare fraud. A patient might commit healthcare fraud by using someone else’s Medicare or health insurance card to obtain coverage for medical care, for example—or a human resources employee could falsify hiring or termination dates to expand coverage periods for employees.

Automobile insurance fraud

Some automobile insurance agents may intentionally add unwanted coverage to policies to collect extra commission money. Other agents may pocket premium payments without setting up collision coverage at all. Whether or not there was malicious intent, these are examples of insurance fraud so long as the actions were done knowingly.

Drivers can also commit automobile insurance fraud by filing false insurance claims exaggerating the severity of an accident, or lying on insurance applications. However, many drivers are unaware that omitting simple details or providing the wrong zip code to an insurance agent can lead to criminal charges so long as the intent was to deceive.

Life insurance fraud

While faking one’s own death to collect millions is one example of life insurance fraud, it’s not the only way to commit life insurance fraud. Many people commit fraud by concealing important health details to get a lower cost premium. While this might seem like an innocent way to save money, it is potentially a criminal act that may subject you to prosecution for insurance fraud.

Forgery—where spouses or other close relatives change the beneficiaries to a policy behind an insurance policyholder’s back—is another common form of insurance fraud.

Penalties for criminal insurance fraud

The penalty for an insurance fraud charge depends on the type of fraud and the value of the property involved. For example, using someone else’s health insurance card to secure a $300 lab test could potentially lead to less severe penalties than forging your spouse’s signature to name yourself the beneficiary of a $300,000 life insurance policy.

Depending on the circumstances of the alleged fraud, you might be charged with a disorderly persons offense, the penalties for which include up to six months in jail and a fine of up to $1,000.

However, many instances of insurance fraud are charged as a second or third-degree indictable offense, with penalties that include several years of jail time and fines from $15,000 to $150,000. In addition to the fines, you could also be required to repay any money allegedly gained through fraud.

Indirectly, the penalties of criminal insurance fraud could also include restrictions on your career. Employers may view the criminal charges on your record as a sign of poor moral character and trustworthiness—especially for positions that involve managing money or sensitive paperwork.

Making a strong case for your defense

If you’ve been accused of filing a false claim, a vigorous insurance fraud defense could lead to your criminal charges being reduced or dropped. Through an independent investigation, your criminal defense attorney may be able to build a strong case based on:

A lack of intent to engage in fraud
A case of mistaken identity
The fact that you were, in fact, entitled to the benefit
Coercion to commit fraud
The prosecutor obtaining evidence in violation of your constitutional rights

The criminal defense attorneys at Dughi, Hewit & Domalewski have extensive experience in determining how to defend against criminal insurance fraud. From negotiating a plea deal to advocating for you in the courtroom, we are committed to working toward the best possible outcome for your unique legal matter.

Contact Us Today!