Insurance fraud encompasses many different types of crimes in many different areas. Essentially, you can commit insurance fraud simply by lying, misrepresenting or otherwise failing to give the correct information to an insurance company, generally by presenting a false claim, to obtain a benefit you would not otherwise be entitled or eligible to receive.

Types of Insurance Fraud

Different governmental and private insurance companies may be defrauded:

  • Auto insurance
  • Unemployment
  • Medicare or Medicaid
  • Property
  • Medical
  • Life

In California, the Department of Fraud may handle an instance of fraud either administratively, such as by revoking or suspending a person’s license, or as a criminal matter.

Auto Accident Fraud

Auto accident fraud may the most common type and is generally found under California Penal Code 550. People may intentionally damage their car and then submit a property damage claim or abandon it and them claim it was stolen. Parties may conspire to and stage phony accidents in which they claim injuries. In this case, the parties involved may be subject to federal prosecution as an organized crime organization.

A simpler case of fraud is claiming that you live at a different address to claim lower insurance premiums.

Auto repair or collision shops also participate in fraudulent schemes by offering payments to insurance adjusters if they refer damaged vehicles to them. Repair shops also fraudulently bill insurance carriers for repairs not made or by claiming to install new parts when used ones are actually employed.

Medical Fraud

Another type of insurance fraud involves health care providers who process fraudulent medical claims by not providing the care that was billed or by exaggerating a patient’s injuries or condition. Other doctors simply bill for patients they never met.

Related Offenses

Related offenses to insurance fraud are many and varied and include:

  • Grand theft
  • Forgery
  • Perjury
  • Conspiracy
  • Counterfeiting

Degree and Penalties

Insurance fraud is considered a “wobbler” offense, meaning it can be charged as either a misdemeanor or felony depending on the severity or sophistication of the offense and prior criminal history of the defendant.

Whether you are charged with a misdemeanor or felony could depend on the amount of the fraudulent claims presented. If the claims totaled $950 or less, it is considered a misdemeanor in most cases unless you have a criminal history.

If you are charged and convicted of a misdemeanor, you face up to 6 months in county jail, a fine of up to $1,000. If the offense was auto insurance fraud, the fines could be $10,000, $50,000 or double the amount of the fraud–all depending on the type of fraud that was perpetrated.

You could also merely be placed in informal probation if your offense was slight and little financial or other harm resulted.

In felony cases, you face 2, 3 or 5 years for medical fraud and 16 months in state prison as well as an additional 2 year sentence for every prior conviction of auto insurance fraud.

Possible Defenses

Defenses to insurance fraud are available to any defendant depending on the circumstances of your case:

  • Lack of Intent

If you legitimately believed you submitted a real claim, you may lack the requisite criminal intent. Also, you may have neglected to provide your current address if you just moved, or inadvertently gave the wrong information.

  • Insufficient Proof

Law enforcement officers and insurance adjusters are trained to be suspicious of claims generally. A low impact accident causing injuries may appear to be embellished but credible medical testimony may refute it. A car reported as stolen may suddenly appear undamaged but is not proof of abandonment; or a medical procedure deemed unnecessary by an adjuster is difficult to prove as fraudulent.

  • Improper Investigative Procedures

Police often make mistakes in gathering evidence by tampering or spoiling an accident scene, overlooking evidence, or illegally seizing evidence. A good criminal defense attorney can exploit these deficiencies and lead to certain evidence ruled inadmissible. This can result in dismissal of charges against you or to a reduced plea.

Immigration Consequences

Under federal immigration law, if you are an alien or permanent resident and you commit a crime of moral turpitude such as insurance fraud, you may have serious immigration consequences. In some cases, you could face potential deportation and not be eligible for cancellation of removal relief.

Call the Law Offices of Ramiro J. Lluis

Facing a charge of insured fraud or a related offense can result in serious prison time and have long range or permanent adverse consequences on your life. If you have been charged with insurance fraud, call the Law Offices of Ramiro J. Lluis today for a free, confidential initial consultation at (213) 687-4412.