Philadelphia Insurance Fraud Defense Attorney

Insurance fraud is considered a “white-collar crime” in that it combines monetary gain with deceitful and fraudulent conduct. Insurance fraud is a criminal offense committed by either an individual, a business, or a governmental entity. It is a scheme that targets a specific form of insurance process and attempts to manipulate it for the monetary gain of the offender. Insurance fraud is a criminal offense that may be met with very serious consequences.

If you or a loved one has been charged with insurance fraud in Philadelphia, then you need to contact The Law Offices of Lloyd Long immediately. Philadelphia insurance fraud defense attorney Lloyd Long can fight for your rights, no matter the severity of your case. We will exhaust all possible defenses to an insurance fraud charge, and we will not rest until your rights as a defendant are protected. Call (215) 302-0171 to reach our Philadelphia insurance fraud defense attorneys today.

What is Insurance Fraud in Philadelphia?

Insurance fraud, in its most basic form, is any act committed with the intent to obtain a fraudulent outcome from any type of insurance process. Insurance fraud may occur when a claimant to an insurance policy attempts to derive a benefit or advantage to which they are not entitled under the lawful portions of the policy. On the other end of the spectrum, insurance fraud may also occur when an insurer knowingly denies some benefit that is rightfully due to a claimant.

Insurance fraud in Philadelphia is a serious criminal offense and comes with serious penalties. Therefore, it is important to know what constitutes insurance fraud. The chief motive in every single insurance fraud case is financial exploitation leading to some form of financial gain. People who commit insurance fraud sometimes justify their actions by saying that the insurance companies can afford to lose some money. They may also feel they are truly entitled to an insurance payout even though, under their insurance policy, they do not qualify. Our Philadelphia insurance fraud defense lawyer can help you understand what exactly insurance fraud is and how to defend against fraud charges.

Common Ways Insurance Fraud is Committed in Philadelphia

There are multiple ways in which a person or entity may commit insurance fraud in Philadelphia. It may be committed by an individual who defrauds an insurance agency. It can also be committed by an insurance agency against an individual. In any case, the fraud occurs through some form of deception. If you are facing fraud charges or accusations, please contact our Philadelphia insurance fraud defense attorney for help.

Fraud by an Individual

An individual may commit insurance fraud by providing false or misleading information to an insurance agency. The information is usually something material or important to an insurance claim and is needed for the agency to make a decision regarding approval of insurance payments. For example, if your vehicle was totaled in a car accident, and you lied to your insurance company about the make and model of your car in order to get a higher insurance payout, that would be insurance fraud.

It may also be insurance fraud to make a false claim for which you know you are not entitled payment. For example, you might be entitled to an insurance payout if your home were to burn down due to natural causes like a lightning strike or by another person committing arson. If you burned down your own home on purpose and then told your insurance company someone else committed the arson, this would be insurance fraud.

Insurance fraud does not need to be committed alone, nor does it need to be committed for your own benefit. It is possible to be charged with insurance fraud by conspiring with another. It is also possible to be charged with insurance fraud if, as part of that scheme, you are not the one who will receive the insurance payout. Even if your partner is the one who receives the payout, you can still be charged with conspiracy to commit the fraud. The same goes for someone who agrees to benefit from the proceeds of insurance fraud even though they themselves did not commit the fraud.

An individual may be charged with insurance fraud for using someone else’s insurance information or identification to receive payments they are not entitled to. In addition to charges for insurance fraud, a person who uses another’s information may be charged with offenses related to identity theft.

Fraud by an Insurance Entity or Agency

Insurance fraud includes more than individuals defrauding their insurance companies. Sometimes it works the other way around. Insurance companies or agencies and their employees may be charged with insurance fraud for defrauding their clients out of money they are entitled to receive.

If an insurance agency or an employee of an insurance agency uses false information or some other form of deception to prevent a client from receiving the insurance money they are rightfully entitled to, that agency and employee can be charged with insurance fraud.

There are also laws that prevent insurance agencies or providers from unlawfully soliciting clients. If an insurance company were to give gifts or rewards to a provider, such as a healthcare worker, in exchange for that provider recommending the insurance agency to patients or clients, they could potentially be charged with insurance fraud. However, this excludes things like normal advertising by the insurance agency.

Types of Insurance Fraud in Philadelphia

Insurance fraud is a term that is all-encompassing. It includes any form of fraudulent conduct surrounding an insurance policy and an attempted wrongful monetary gain therefrom. There are numerous types of insurance fraud because there are many kinds of insurance. The exact nature of someone’s criminal fraud scheme will depend on the type of insurance they are defrauding.

Here are some of the most common forms of insurance fraud charges in Philadelphia:

The Stolen Car

This form of insurance fraud occurs where an owner either sells or destroys their own vehicle in order to take advantage of an insurance policy on their car. The perpetrator will often tell their insurance company the car was stolen. If successful, they will be compensated by their insurance company for the value of the car.

Car Accident/Car Damage

This occurs after an owner of a vehicle purposefully damages their own car in an accident in order to collect an insurance payoff. Many times, the insurance payoff is inflated for the vehicles involved in an accident, and claimants fail to get the vehicle fixed after collecting the insurance payouts.

Health Insurance Billing

This form of insurance fraud is committed by health care professionals. Typically, they will bill an individual’s insurance for more treatments than the patient actually received. For example, if you went to a surgeon for a routine surgery, and they bill your insurance company for the surgery in addition to another procedure you did not receive, that would be fraud.

Unnecessary Medical Procedures

Unnecessary medical procedures are another way for doctors and other medical personnel to commit insurance fraud. In these scenarios, the patient is the victim of the insurance fraud because they are given an unnecessary procedure so that the physician can procure a financial gain. Not only can the doctor involved be penalized for insurance fraud, but they may face consequences for medical malpractice for subjecting patients to unnecessary procedures.

Staged House Fire

This is one of the most common homeowner’s insurance fraud. Often an individual is hired to stage the “accidental fire,” and the individual has taken out some form of insurance coverage on the items in their home. This is often perpetrated when the defendant needs to demolish a house or finds himself unable to sell a house. Many perpetrators use this method of fraud as a way of getting rid of their “money pit” homes.

Faked Death

For this form of fraudulent insurance scam, a claimant will typically take out a life insurance policy on him or herself, with the spouse as the beneficiary. After the policy activates, the insured will fake their death and the spouse will then be paid the death benefit.

This list is not exhaustive and there are many other forms of insurance fraud that are not mentioned here. If you believe you might be caught up in an insurance fraud scheme, reach out to our Philadelphia insurance fraud defense attorney as soon as possible for a consultation.

Penalties for a Insurance Fraud Conviction in Philadelphia

The penalties for insurance fraud are severe and should be taken seriously. In Philadelphia, most insurance fraud offenses may be charged as a third-degree felony. For a third-degree felony, a defendant may face no more than 7 years in prison. Your exact prison term will likely depend on the nature of your offense and the amount of money you fraudulently obtained. For offenses involving unlawful or improper solicitation for services, as mentioned above, a defendant may be charged with a misdemeanor of the first degree. Such a misdemeanor may be punishable by a maximum of 5 years in prison.

In addition to a prison sentence, the court may require you to pay restitution to anyone harmed by your insurance fraud scheme. This will involve paying back the money you obtained through your fraud scheme. You could also be sued in civil court for damages. To fully understand the penalties for insurance fraud, reach out to our Philadelphia insurance fraud defense attorney for guidance.

Our Experienced Philadelphia Insurance Fraud Attorneys Can Fight for You

If you or a loved one has been accused of committing insurance fraud, credit card fraud, or medicare fraud in Philadelphia, then you need to contact the attorneys at The Law Offices of Lloyd Long. We have years of experience defending clients against a wide range of misdemeanor and felony charges in Pennsylvania, including sex crimes, drug crimes, and “white collar” crimes like insurance fraud. We will protect your loved one’s legal rights while vigorously fighting the charges on their behalf.

Insurance fraud is an extremely serious crime. With serious crimes come serious consequences, and you need an attorney that you can trust who will fight for you every step of the way. To discuss your legal matter in a completely private case consultation with a Philadelphia criminal lawyer, call our law offices at (215) 302-0171 today.