Insurance fraud is one of America’s largest crime industries. It occurs every day in every state. People of all races, incomes and ages are victimized. Fraud committed against private insurance companies costs Americans at least $80 billion a year, or about $950 per family. Medicare fraud costs the federal government $179 billion per year.
Insurance fraud consists of fraudulent activities committed by applicants for insurance, policyholders, third-party claimants, or professionals who provide insurance services. Insurance fraud can be “hard” or “soft.”
Hard Fraud. This is when someone deliberately fakes an accident, injury, theft, arson or other loss (or worse, such as a life insurance beneficiary killing an insured) to collect money illegally from insurance companies. Many act alone, but increasingly, organized crime rings stage large schemes that steal millions of dollars.
Soft Fraud. People often tell “little white lies” to their insurance company. A car owner inflates a fender bender claim to cover her deductible. A homeowner inflates the value of his stereo equipment stolen during a robbery. These are crimes.
Even though the federal government is more actively involved in the pursuit and prosecution of some insurance fraud cases than it used to be, it is the state insurance departments, state attorneys general and county district attorneys offices that do most of the investigation, enforcement and prosecution of insurance fraud because most of the anti-fraud laws are state statutes.
Frequently, however, insurance fraud cases result in federal prosecution because the fraudulent activity (doctor illegally using prescription drugs, doctor diluting medication resulting in injury or death of patients, unnecessary surgeries, murder) also violates federal law. Also, Title 18 of the U.S. Code, Section 1033 is used to prosecute anyone engaged in the business of insurance (executives, employees, sales agents) who is involved in the perpetration of insurance fraud. And, of course, federal laws are violated whenever there is a case of Medicare, Medicaid (federal and state laws) or Tri-Care (military insurance) fraud.
As the pursuit of fraudulent activity by state and federal authorities intensifies, the penalties have increased. Mandatory restitution of lost income, loss of professional license and substantial prison sentences can result from a conviction for insurance fraud.
If you are under investigation for, or have been charged with, insurance fraud, contact Criminal Attorney Bonavita right away. Criminal Defense Attorney Bonavita is an experienced insurance fraud lawyer that can help preserve your rights and defend you in the face of federal prosecution. Call Criminal Attorney Bonavita at 978-376-6746 or Email her immediately.
Motor Vehicle/Accident Fraud
Presenting or submitting a fraudulent insurance claim to a motor vehicle insurance company is a crime punishable with imprisonment for up to 5 years in State Prison, or to the House of Corrections for not less than 6 months and up to 2.5 years.
In order to be convicted of the crime of Fraudulent Claims for Motor Vehicle Insurance Policies, the prosecutor must prove, beyond a reasonable doubt:
- That the defendant either presented or aided in presenting to an insurance company a notice, statement, or proof of loss in connection with a support of a claim under a motor vehicle insurance policy;
- That the false statement was significant to the claim;
- That the defendant knew that the statement was false; and
- That the defendant intended to injure, defraud or deceive the motor vehicle insurance company.
Massachusetts General Laws Chapter 266, Section 111B, which proscribes the criminal offense of Fraudulent Claims for Motor Vehicle Insurance Policies, covers misrepresentations made in connection with claims under a motor vehicle, theft, or comprehensive insurance policy; whereas the Massachusetts criminal statute for Fraudulent Insurance Claims, General Laws Chapter 266, Section 111A, covers fraudulent claims for all types of insurance.
Medicare or Medicaid Fraud
Indictments for health care fraud are on the increase in Massachusetts, Vermont, Rhode Island and throughout New England. Federal prosecutors are targeting physicians, medical groups, providers and vendors who accept medicare or market, sell or provide FDA regulated devices, equipment or medications. Billing and reimbursement practices, sales tactics and financial reward systems have come under scrutiny and resulted in numerous prosecutions.
While ignorance of the law is not a defense, ignorance of wrongdoing is. Often financial crimes are perpetrated by third or insulated parties without the knowledge of the accused. Mistakes of fact or inaccurate advice from a licensed professional may also constitute a defense depending upon the circumstances. In federal court, such defenses are usually rebutted by the prosecutor with a willful blindness instruction. In other words, a defendant who is faced with evidence that he (or she) is involved in an illegal scheme, cannot stick his or her head in the sand and purposefully remain ignorant of the illegality.
Credit Card Fraud
This includes any crime where goods are paid for with false credit cards, or money is stolen from an account using a stolen credit card. Credit card fraud costs billions of dollars each year. Credit card fraud can happen when an actual card is taken from the original owner and used to buy goods, or when the numbers of the card are taken and used on falsified receipts, to purchase items through the Internet or through the mail, or to access money in a compromised account.
Credit card fraud can also be used to open a new account in the credit card holder’s name, or to open an account using stolen or fake documents. Skimming and carding are two other methods used; skimming is when devices at automated teller machines steal credit card information as the card is used legitimately, while carding is when a stolen card is used to buy a small item online to show that the card has not yet been reported stolen. If the transaction goes through, the thief can then use the card to purchase more expensive items with the same card before it is declined because it has been reported stolen.
If you are facing charges for Fraud in Newburyport, Salem, Boston, Amesbury, Salisbury, Lawrence, Ipswich, or any town in the Essex, Suffolk, or Middlesex counties in Massachusetts, call Criminal Attorney Bonavita immediately at 978-376-6746 or email her with your case information!