The Montgomery County Insurance Fraud and Arson Unit were established in 1996 in efforts to conduct investigations and pursue criminal charges in instances of insurance fraud. The unit also provides training for members of local agencies of law enforcement and conducts public campaigns to heighten awareness regarding these types of crime. They define insurance fraud as a crime that may be committed by an individual or organization where facts are misrepresented in order to derive a benefit.
Across the state of Pennsylvania between 2013 and 2017, there were approximately 2,574 cases of insurance fraud. In 62% of these cases, either a conviction was secured or the alleged offender entered a diversionary program such as Accelerated Rehabilitative Disposition. Roughly 57% of these offenders were male and 80% of them were between the ages of 26 and 65 years old.
Insurance Fraud Defined (§4117)
The Pennsylvania Code contains a lengthy set of provisions that explains the many ways that the crime may be committed. It commonly involves intentionally providing information that is “false, incomplete, or misleading” to defraud an insurer. In many cases, policyholders will commit the crime by inflating the true value of losses or damages. Fraud may occur in any form of insurance such as automobile, homeowners, health, and workers compensation.
Criminal Charges and Penalties
In most cases, the crime is a third-degree felony offense, which is punishable by up to seven years of imprisonment and a maximum fine of $15,000. Under certain circumstances, the offense may be a first-degree misdemeanor with a maximum sentence of five years and a fine of up to $10,000. The court may also order that the convicted party make restitution for the losses incurred by the insurer.
Automobile Insurance
There are various ways that fraud may occur with automobile insurance. A policyholder may “stage” a collision to appear as an accident in order to make a claim for compensation. Someone involved in an accident may falsely claim to have been injured or claim that their vehicle was stolen when it was not.
Health Insurance
There are many ways that someone may defraud Medicare, Medicaid, or a private insurer. A policyholder may submit a phony receipt to obtain reimbursement for a product or service that they did not receive. A medical provider may intentionally bill a patient's insurance company for a service or procedure that is more costly than what was actually rendered. A provider may bill the insurer for medical tests or procedures that were not necessary in order to obtain reimbursement.
Why is Retaining Seasoned Legal Counsel Critical in These Cases?
In Pennsylvania, The Office of Attorney General's Insurance Fraud Section has grown into one of the largest divisions of law enforcement in the state. Statewide, there have been significant resources devoted to promote awareness about the crime and to investigate cases thoroughly. Many county prosecutors tend to be overzealous when bringing charges relating to insurance fraud. In some instances, investigators and prosecutors may be in a rush to judgment and not properly consider the rights of the accused.
Attorney Represents Clients Facing Insurance Fraud Charges in Montgomery County
Being convicted of fraud can lead to a lengthy sentence of incarceration in addition to the long-term consequences associated with having a criminal record. Our Criminal Law Team will work tirelessly to defend such allegations in the Montgomery County courts. For a complimentary case evaluation, contact the office today at (888) 535-3686.
