In 2016 a group that included the operator of more than 30 Miami-based nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion fraud scheme. The charges and allegations contained in the official indictment were accusations and the group was presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
Insurance fraud occurs when an individual – or a group of people, as in the case of the $1 billion Medicaid scheme uncovered earlier this year – deliberately deceive an insurance company to receive money to which they are not actually entitled. Insurance fraud is illegal in all 50 states, and depending on the extent of the fraud and the state legislature, in which it occurred, can be charged as either a felony or a misdemeanor. When an individual commits insurance fraud, they are not hurting the insurance company so much as they are hurting other policyholders, as for every scam committed against an insurer, the insurer must raise its premiums to compensate for the money lost. Because of the negative effect that insurance fraud has on several innocent parties, the penalties for committing insurance fraud are severe.
Insurance fraud occurs in many forms.
This occurs when a person or business defrauds a health insurance provider.
For example, a person might claim to have a false injury in order to obtain payments or prescription medication. This type of fraud also commonly occurs when health care providers, such as doctors or dentists, submit claims to a health insurance provider for procedures they did not actually perform. As well as being a crime in all fifty states, health care fraud is also illegal under federal law.
This occurs when someone either exaggerates or fabricates a claim made to his or her automobile insurance provider. For example, a person may claim that the extent of damage that occurred in an automobile accident was greater than it actually was, in order to obtain a larger payment from the insurer.
This happens when a person attempts to obtain life insurance payments by fabricating their own or another’s death. For example, a person who forges a death certificate of a family member to obtain his life insurance payment has committed fraud.
This is fraud concerning home, business, or other insurance policies covering real property (land or buildings) or personal property. A business owner who sets fire to his own business has committed this type of fraud. An owner of a valuable piece of jewelry may claim that the item was lost, in order to obtain a payment. Property insurance fraud may also include exaggerating the damages from a legitimate loss—for example, a person who had a pipe burst in his home might claim damages in excess of those that actually occurred in order to obtain a larger payment than otherwise would be awarded.
Defending our clients against fraud is one of many areas of practice Carlos Gonzalez Law performs. Don’t wait. Contact us for a free consultation now.
For any questions or concerns regarding your case please call our office at (786) 358-6888