Criminal Defense White Collar Crimes

Insurance Fraud Defenses

Insurance Fraud Defenses
Edited by Saul Bienenfeld

Insurance fraud is a crime that covers a broad range of conduct.  It can include unemployment insurance fraud, auto insurance fraud and many other areas.  Being charged with such a crime naturally involves a feeling of horror, mostly because the client has usually already received the insurance payment and spent it, meaning he or she cannot quickly pay back the money received.

What to Take Away:  Insurance fraud is a felony that can result in two years or more of state prison, although probation is certainly possible, especially if one is able to pay back the insurance company for the money obtained illegally.  Health insurance fraud, however, is a wobbler, meaning it can be charged as a felony or a misdemeanor, depending upon the facts of the case and defendant’s criminal history, if any.

First Steps If You Are Audited, Investigated or Accused

  • Contact a federal insurance fraud attorney.
  • Organize your information. Part of defending yourself against accusations of fraud is performing your own investigation.  While government agencies are gathering information and working against you, it is up to you and your attorney to organize your information and present it in a way that evidences your innocence.  This can include hiring an independent auditor claim specialist. Protecting your confidential information is essential during this process.

  • Avoid incriminating statements. There is an inherent risk when making statements to agencies and investigators. Having representation during questioning is essential.  Also, keep in mind, most phone calls to insurance companies are recorded.
  • Rectify inaccurate information. If you realize that you have made a misrepresentation to your insurance company or the investigating agency, or if you realize that you have omitted some valuable piece of information, you should speak with your attorney about rectifying those statements.

4 Best Defenses to Insurance Fraud

  1. You did not knowingly commit a scheme to defraud.
  2. You did not knowingly make a false statement.
  3. If you did make a false statement, it was not material.
  4. Damages claimed were accurate.


About the author

Saul Bienenfeld