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New York City Criminal Attorneys Will Fight for You When Insurance Giants Accuse You of Doing Wrong

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Insurance fraud can be defined as the fraudulent act of an insured person to obtain payment or benefits from an insurer. Insurance fraud can take many forms and be committed in any situation where there is an insurance policy. Insurance fraud is a severe crime, and powerful insurance companies will press for heavy fines and severe penalties.

An insurance fraud defense lawyer who is familiar with trial advocacy and insurance law will be able to defend you against any accusation of insurance fraud.

What is insurance fraud?

Most people associate insurance fraud with auto accidents. This is where the fraudster claims that the vehicle was damaged or stolen. However, there are many types of insurance fraud.

For example, someone could claim to have a chronic condition to be eligible for long-term disability or extended Workmen's compensation. Medicaid fraud and Medicare fraud can also be types of insurance fraud. This is when a doctor takes advantage of the fee-for-service structure to upgrade or downgrade the medical codes to get more money or help their patients with their insurance services.

Insurance fraud can also occur on the part of the insurer. Many instances of insurance fraud have been reported.

Insurance fraud is committed by agents or insurance agencies. These crimes can lead to criminal charges against the company or the individuals who work for the insurer and are responsible for fraud schemes.

Types of insurance fraud

Different types of insurance fraud may result in additional criminal charges and penalties. The most common forms of insurance fraud are:

No matter the type of insurance fraud you are accused of, a prosecutor must prove it.

To gain value, you may have provided false or misleading information to an insurance company. You could be charged if you try to profit from an insurance contract to enrich yourself at the insured's expense.

Fraud in Auto Insurance

Infractions of auto insurance fraud could include:

  • Vehicle dump: A vehicle is left by its owner in a poor neighborhood to be stolen. The owner can also decide to sell or burn the car. An owner may also claim that the vehicle was stolen and file an insurance claim to its value.
  • Faking or staging accidents: There are many ways to produce auto accidents. A scoop and squat is a sudden collision between two cars, which causes the rear to collide with the front. Driving down is when a driver stops at an intersection and waves a vehicle forward, then goes in the other's direction. Sideswipe is when a driver drifts into a car and makes a turn, even though there are two lanes.
  • Faking or exaggerating accident injuries: Soft tissue damage, including soft tissue injury, is easy to fake. There's no medical test that shows the extent of the injury. These insurance fraud schemes are often facilitated by doctors who also work with drivers. Sometimes, the injuries are exaggerated in an accident.
  • False address registration: Insurance for your vehicle can be more expensive in certain areas than elsewhere. New York has many areas with high auto insurance rates. Drivers may choose to register at a different address to lower their insurance premiums.
  • Exaggerating repair cost: Drivers take their cars to repair shops that give high estimates, which the insurance company pays. Drivers are then able to get their repairs done cheaper or even without any repairs at all. The scammer may be the body shop or the insured.
  • Faking airbag repair: When a mechanic or body shop charges an insurance company to replace an airbag but never does so, this type of insurance fraud is committed.

The state-level is usually where auto insurance fraud is prosecuted. Any suspected insurance fraud must be reported to the Insurance Department's Fraud Bureau by all licensees, brokers, agents, and insurers.

Motor insurance fraud is punishable by severe penalties. The New York Code outlines the crime of insurance fraud in New York. Depending on the number of funds obtained, a defendant could be charged with insurance fraud in any of the following degrees: first, second, third, or fourth. For those who have more minor fraud schemes, insurance fraud in the fifth grade is a Class A misdemeanour.

Other insurance fraud offences that exceed $1,000 are felonies.

Fraud in Health Insurance and Dental Insurance

Insurance companies can be liable for health insurance fraud or dental insurance fraud. You can commit health care fraud or insurance fraud by:

  • To bill for services that are not medically necessary, you must perform them.
  • It is possible to bill for services not rendered or services that are more expensive than the actual services provided.
  • It is wrong to lie about the type of treatment that was used to be covered.
  • Falsifying patient records to obtain coverage for treatments not covered
  • Unbundling or billing for multiple insurance codes, for procedures that should only be billed under one code combination
  • Referring patients? Rewarding them with kickbacks 
  • Overbilling insurance companies and waiving patient-deductibles
  • To get lower premiums for insurance, you can lie about your health.
  • To get medical care, you can use the insurance of someone else.

Insurance fraud penalties can be severe, especially when they involve Medicare or Medicaid. If fraudulent claims for dental or health insurance are made against government programs, it usually results in federal charges rather than state charges. The following federal laws apply to insurance fraud:

Federal authorities can order the asset freeze of providers suspected of participating in fraud related to health care under 18 U.S.C. Section 1035. If convicted of fraud in health insurance or dental insurance, permanent forfeiture is possible.

Fraud in Life Insurance

A life insurance fraud can be as simple as faking death or purchasing insurance policies for someone who has never existed. To collect insurance benefits, you can also kill someone. However, this could lead to murder charges. Therefore, the insurance fraud offense is often secondary.

Other types of insurance fraud are also common and can be committed by either policyholders or agents. These are just a few examples:

  • Stealing premiums: An agent who sells life insurance policies takes money from the customer and not sends it to the insurer to secure or keep coverage.
  • Fraudulent upselling: An agent selling insurance makes misleading statements to persuade a policyholder that a higher-cost policy does not offer better coverage.
  • Fraud in life insurance and annuity fraud: Insurance agents offer clients annuities at exorbitant prices, using material misstatements. They also do not explain limitations. 
  • Life insurance funds that are not oriented towards the elderly. Seniors buy life insurance policies to sell them to hedge funds. Settlement companies are often involved in these transactions. They make misleading statements to seniors or don't disclose that policies can't legally be sold.
  • Seniors who have valid policies might be offered money to buy them, sometimes for more than the market value. Seniors with good policies will be provided cash to investors who will collect the premiums when they die. Senior Life Settlements (S.L.S.) can be packaged and sold under the name "death bonds."

Life insurance fraud is often prosecuted at the state level, just like motor vehicle insurance fraud. These fraud schemes involve thousands of dollars in losses due to expensive life insurance policies and often pay high death benefits.


Additional Insurance Fraud Penalties

 Federal insurers are most likely to be the targets of your fraud. There are also other circumstances where federal penalties could be applied. For example, you could be charged with the following:

  • Wire Fraud if you use radio or television as part of an insurance scheme.
  • Mail fraud or postal fraud, if you use the mail to commit insurance fraud.

Maximum penalties for wire and mail fraud are 20 years imprisonment. In general, federal offenses relating to insurance fraud can lead to decades of incarceration.

The Challenges of Defending an Insurance Fraud case against You

We can assist you if you've been charged with insurance fraud or have been the victim.

Associations can bring about insurance fraud cases. We at Bukh Law Firm have the experience and expertise to assist with complex fraud cases.

How insurance fraud attorneys can help

If your future is at risk, you should contact the top New York criminal law firm. The attorneys at Bukh Law Firm are available to assist you in all phases of the criminal legal process, from pre-trial investigations and negotiations through trial.

Some of the most experienced N.Y.C. defense lawyers can help you negotiate with your prosecution. Contact us today for more information.


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