Any attempt to deceive an insurance carrier, whether private or public, by making a false claim is actionable under federal law as insurance fraud. Many types of insurance policies can be the basis for these prosecutions.
While the term “insurance fraud” is a term of art that connotes a specific victim (insurance carriers) and type of deception (filing a false claim), most often these crimes are prosecuted under generic fraud statutes such as 18 USC 1341 (mail fraud), 18 USC 1343 (wire fraud) and 18 USC 371 (conspiracy to defraud the United States).
Unlike wire and mail fraud, a “371 conspiracy” carries up to 5 years imprisonment. In these prosecutions, the Government does not need to establish use of a telephonic, online, or postal carrier. Rather, it is only necessary to establish that the victim was a United States entity (or some other federal nexus regarding the victim) at the time of the offense.
Insurance fraud prosecutions may target individuals, groups of people, or even companies. This means that persons who cause damage to insured property could be held equally liable to persons who actually file falsified claims related to the intentional harm to insured persons or property. The fact that fraud schemes can include multiple people is significant because an increase in prosecution targets offers prosecutors an increase in potential cooperators and sources of evidence.
Individuals accused of insurance fraud need help at the beginning stages of an investigation. It is common for federal or state agents (such as a state’s department of insurance or the FBI) to attempt to interview targets by surprise. This is often accomplished via visits to a target’s place of employment or home. People contacted by law enforcement officials need to be careful when interacting with law enforcement officials.
Also, as these cases require the review of sometimes confusing, technical insurance policies and documents as well as financial records, it is important to have competent legal representation. It is also important for defense attorneys to arrange for experts to evaluate claim data and bank records to determine the proper monetary scope of the claim. This can have a substantial impact if a person receives a sentence for insurance fraud.
Federal sentences regarding mail and wire fraud are typically addressed under section 2B1.1. Just as in healthcare fraud, wire fraud and mail fraud sentences are driven primarily by the amount of loss. This means that the policy claim drives a federal sentence. Further, it is important to understand that insurance fraud cases include the concept of intended losses. This means that if an insurance scheme is thwarted, the fact that a client didn’t actually get away with any monetary gain will not decrease criminal culpability of mitigate a sentence.
Challenging loss amounts is an often overlooked aspect of defending an insurance fraud case. Organizing and preparing the presentation of expert accounting evidence to challenge the Government’s loss estimate can make a tremendous impact upon a federal sentence. If a defendant simply allows a loss amount to stand without review or challenge, it could cost them months or years of freedom.
Due to the potentially severe penalties for a conviction of federal insurance fraud in Fort Worth, anyone facing allegations should seek the services of a hardworking and skilled lawyer for legal assistance as soon as possible.