As national healthcare policy has become a widely discussed topic in recent years, more attention has been focused on fraud involving healthcare. Many mistakenly believe healthcare fraud is mostly committed by people who simply choose not to work and opt to receive government health benefits that are intended for people with disabilities and low income. On the contrary, most health insurance fraud perpetrators are criminal organizations and, in some cases, doctors and health facilities. These people also commit insurance fraud against private insurance companies. A doctor or health facility staff member engages in billing fraud if he or she:
- bills an insurance company for services a patient did not receive
- orders unnecessary medical tests and procedures for the purpose of billing the insurance company for a larger sum
- bills an insurance company for a service that was more expensive than the treatment the patient actually received
- bills an insurance company for each step in a service as if each step is a separate treatment
Homeowner’s insurance (HOA)
In some cases of fraud, a homeowner may fake an accidental fire or report an act of vandalism that is pre-orchestrated by the homeowner. Staged fires always occur when no one is at home and after the homeowner’s valuable items have been removed. Prior to staging a fire, some fraudsters may ensure the insurance company is aware of the value of the expensive items in the home and leave them in the house before starting the fire. In other cases, the homeowner may stage a flood or break-in and possibly claim damage to valuable items that never existed or were never kept in the home. Abandoned house fraud is a variety of homeowner’s insurance fraud in which a homeowner has a fire staged at a house in which he or she does not currently reside. Houses that have been listed on the market, but are not selling are common targets of this type of fraud.
Renter’s insurance covers the contents of a rental unit and may also be used to compensate people who are injured on the rental property. Renter’s insurance fraud and homeowner’s insurance fraud are similar in that the person whose name is on the lease will typically stage a fire, flood, or other destructive act in the interest of receiving payment from his or her insurance company by claiming the loss of valuable items inside the rental property.
As residents in West Palm Beach and across Florida know, hurricanes do happen. Although most people file valid claims to receive the help they need after their property is damaged by a storm, fraudsters seize the weather event as an opportunity for financial gain. Some people commit fraud by exaggerating the extent of the damage the storm did to their property while others may have received no storm damage at all but will falsely claim damage and request compensation from their insurance company. Insurance providers are typically very busy following a major storm; therefore, companies may be less likely to detect certain fraudulent claims.
Life insurance fraud often appears in story lines on soap operas and prime time TV shows. An insurance fraud scheme typically involves one person faking his or her death and disappearing. Next, the individual’s spouse or another close family member will collect the insurance payout then disappear shortly after to rejoin the person who faked his or her death and share the proceeds.
We’re here when you need help
People may think they can make slight misrepresentations on an insurance claim to receive a higher payout, but in reality,doing so may constitute a federal criminal charge. Anyone who has been accused of insurance fraud should immediately contact a West Palm Beach insurance fraud defense attorney prior to speaking to an investigator. A federal criminal lawyer can help people who have been accused of fraud defend themselves against a serious accusation that may otherwise result in a hefty fine or lengthy prison sentence.