Insurance fraud [Fla. Stat. § 817.234] is a serious crime in Florida, as it is throughout the U.S. It is defined in the statute as “an action a person takes with the intent to fraudulently obtain payment from an insurance company or insurer.” According to the Florida Division of Insurance Fraud (which investigates all such cases), it received and acted on more than 16,000 allegations of insurance fraud in the fiscal year 2013-2014. The state will pursue fraudulent claims, so it is best to have an insurance fraud attorney in St. Petersburg like those at Goldman Wetzel on your side if you are being investigated for or were arrested for insurance fraud.

Fraudulent insurance claims can happen in virtually every area of the industry, including:

  • Homeowners’ or property insurance;
  • Health insurance;
  • Car insurance; and
  • Life insurance.

If someone intentionally destroys his home or property, files a false claim for damaged property, or stages a car accident with the idea of collecting illegal payments from his insurance company, he will be charged with insurance fraud. Those who submit false claims for medical services or procedures they did not receive can lead to fraud charges as well. And insurance company employees can be charged with fraud when they set up false accounts and siphon claim payments into bank accounts that are set up to receive them or conspire to share the proceeds of their fraudulent acts with third-party account holders.

Penalties upon conviction for insurance fraud in Florida are unique to the specific crime and the facts of the case. Prison sentences generally follow Florida’s felony theft statutes, which can range from five years in prison for third-degree grand theft to 30 years for a conviction of first-degree grand theft [Fla. Stat. § 812.014].

If convicted of insurance fraud, a person often has to pay not only the mandatory court costs, but restitution as well. Our lawyers can minimize the case disposition and potentially prevent the filing of charges if the accused can pay restitution in advance.

Federal Insurance Fraud and Defenses Available to the Accused

Most federal insurance fraud cases surround government healthcare programs (Medicare and Medicaid), which the government may prosecute and penalize under section 18 U.S.C. 1347 of the Federal Criminal Code. These federal offenses occur in the same fashion as Florida offenses, but what makes them federal crimes is the victim is the U.S. government, rather than a private insurance carrier.

Those convicted of health care fraud suffer serious criminal penalties. But they also can be exposed to civil penalties. Sentences can range from 10 to 20 years in prison. Those who make false statements on a Medicaid or Medicare claim can face a fine of up to $250,000 per offense. Organizations that make false claims face up to $500,000 for each count.

And regardless of whether the conviction occurs in a federal or Florida court, the perpetrator must reimburse the victim insurer for the amount of money lost in the fraudulent act. If convicted in federal court of fraud, in many cases, the defendant will be required to pay part of the trial costs.

Defenses that may apply to state or federal insurance fraud charges include:

  • Lack of intent to deceive or defraud.
  • The claim or information is not fraudulent or false.
  • Mistake of fact (i.e., the defendant truly thought the fire that destroyed his house was an accident, and it later comes to light that someone purposely set the fire without the defendant’s knowledge).

If you are being investigated for insurance fraud, regardless of whether you are suspected of filing a false claim or work for a company accused of fraudulent activity, the sooner you hire defense counsel, the better. The fraud defense attorneys at Goldman Wetzel in St. Petersburg can represent you during the investigation and help you mount a strong defense if you are later charged. Whether you are charged in state or federal court, contact our knowledgeable attorneys at 727-828-3900 or fill out an online contact form to arrange a free evaluation of your case so we can help you obtain the best possible outcome to these serious charges.

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