Insurance attorneys at Joseph Potashnik & Associates PC have built an excellent track record of defending individuals accused of various types of insurance fraud in state and federal courts.

This offense can take many different forms. In general, it is any conduct that involves making false statements or intentional misrepresentations to an insurance carrier in order to obtain some financial gain.

The most common types of insurance-related offenses are:

  • auto insurance fraud (including staging fake accidents and submitting fraudulent damage reports);
  • health insurance billing fraud committed by healthcare professionals, which includes Medicare, Medicaid, and private providers;
  • Medicaid fraud committed by recipients;
  • property and home insurance fraud (including staged home fires);
  • life insurance fraud.

There are also some other types of fraud which include unemployment insurance fraud, workers comp fraud, and fraud committed by insurance industry professionals such as theft and diversion of money, both the types of stealing from the insurer.

What Makes Insurance Fraud Investigations Different from Other Types?

Such investigations are different from other criminal or semi-criminal investigations because often they are conducted not by government law-enforcement agencies but rather by insurance companies themselves. Based on our experience in dealing with insurance providers’ inquires, we can say that these companies often engage in “audits” and “investigations” not because they act on suspicion of fraud but because they use the investigative process as a means to avoid payments by using the power of intimidation.

This of course does not suggest that all such inquires are baseless. There are many legitimate investigations that result in criminal prosecution and conviction. However, an experienced insurance fraud defense attorney may be able to prevent extreme results and provide protection to the client who is subject to such inquiry.

The New York insurance fraud criminal lawyers with Joseph Potashnik and Associates PLLC have represented individual and corporate clients in insurance audits and inquiries with a high degree of success.

In all inquiries conducted by the insurers, it is our primary goal to protect the client and the client’s business. In several recent cases we represented physicians who were targeted by the insurance companies’ investigators for alleged fraudulent billing practices. After mounting an aggressive defense strategy, the cases were terminated and no referrals to law enforcement agencies were made.

Insurance Audits of Healthcare Professionals

Insurance companies in the United States are extremely aggressive when pursuing fraudulent claims, but they often abuse policyholders and enrolled providers where they feel they can get away without paying. A common practice used by many major carriers is to target a healthcare provider, usually a small to medium size medical practice. Normally, the practitioner receives a request from the insurer asking to provide records for a limited number of patients, from 10 to 20 in total. They justify the request by real or assumed provision in the provider agreement (in cases it exists). When the providers complies, whether or not they have the authority to make such demands, the carrier’s auditors examine the files, always find some inconsistencies, irregularities, errors, real or perceived, and determine that the provider overbilled the insurer. Then they extrapolate these numbers and apply them to all or most patients of the practice, demanding huge payments. Our insurance attorneys have successfully represented a number of physicians and medical practices in cases like this, achieving great results. We recommend that healthcare practitioners audited by any carrier speak with an experienced insurance lawyer before turning over any documents to the investigators and auditors.

In cases involving healthcare insurance, especially if government programs such as Medicaid and Medicare are involved, regular audits may and do often turn into full scale criminal investigations that can jeopardize the practitioner’s ability to practice. Speak to us before discussing the case with the auditors.

In New York, related offenses can be charged as a misdemeanor or a felony, depending on the circumstances of the case. With felony charges, it depends on the scale of crime, charges ranging from a Class E felony to Class B felony.

Anyone under investigation for related criminal offenses in New York should contact an experienced New York insurance fraud defense attorney as soon as they find out that they are being targeted. Our NYC criminal attorneys are here to help with all related matters. Call us today to set up an immediate consultation.

Why People Commit Insurance Fraud?

We’ve seen a few reasons in our practice (and we’ve handled many of them). Sometimes, it’s just greed, plain and simple. After all, everyone knows that insurance companies are rich, so it’s not a big deal if they lose some money. Many people commit this crime because of financial necessity because they are just struggling making ends meet. Others simply don’t view it as something wrong because it’s hard to identify an insurance company as a “victim”. In their mind, robbing a bank is clearly wrong, but taking a claim to which one is not entitled is not necessarily bad.

How Serious of a Crime Is Insurance Fraud in New York?

Under New York Penal Code, insurance fraud can be anything from a Class A Misdemeanor to a Class B Felony. It all depends on how much money the insurance carrier lost as the result of the crime. So, in more serious cases involving large amounts of money, a conviction can result in prison time. If you are not a US citizen and the claim is over $10,000, you are likely to be deported. Even if the claim is smaller than that, you can be deported because insurance fraud is a crime of moral turpitude.

What Can I Do If I’m Investigated for Insurance Fraud in NYC?

The first thing to remember is not to speak with investigators. If they come to you with questions, you can assume that they already know most answers. Don’t make it worse by making statements that will incriminate your. Besides, it won’t even help you to “spill” everything to the investigators.

The way to handle it is to ask for the investigator’s contact information and tell them (politely but firmly) that you will speak with your attorney first and the attorney will get back to them.

We’ve had countless cases where we intervened on behalf of our clients early in the process and were able to prevent arrest and prosecution. There were so many cases where our clients were already arrested but the outcome was much better than it could have been.

Such investigations take months to develop. There can be plenty of time to solve the problem before it’s too late if you handle this right. If you have any questions concerning related matters in New York, call our experienced NYC insurance fraud lawyers today at (212) 577 6677 to set up an immediate consultation.