NYC Insurance Fraud Lawyers

New York Insurance Fraud Lawyers at Norman Spencer Law Group PC’s law firm have built an excellent criminal defense track record of defending individuals accused of criminal charges and various types of insurance fraud in New York state and federal courts.

Insurance fraud offenses can take many different forms. In general, any conduct and acts involving making false statements or intentional misrepresentations to an insurance carrier to obtain some financial gain.

• Health insurance fraud committed by healthcare professionals involving billing, which includes Medicare, Medicaid, and private providers;
• Medicaid fraud committed by recipients;
• Property and home insurance fraud (including staged home fires); and
• Life insurance fraud.

There are also some other types of insurance fraud, which include the following:

• Unemployment insurance fraud
• Workers compensation fraud
• Auto insurance fraud
• Insurance policy fraud committed by insurance agents and insurance company professionals, such as theft and diversion of money, both stealing from the insurer.

Insurance fraud case investigations are different than other criminal or semi-criminal investigations because often they are conducted not by federal government law-enforcement agencies but rather by insurance companies themselves. As New York insurance fraud attorneys experienced in dealing with insurance providers’ insurance fraud issues and inquiries often engage in “audits” and “investigations,” not because they act on suspicion of insurance fraud but because they use the investigative process as a means to avoid payments by using the power of intimidation.

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

The insurance fraud New York criminal defense lawyers with Norman Spencer Law Group PC have represented individual and corporate clients in insurance fraud audits and inquiries with a high degree of success.

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

Insurance companies in the United States are highly aggressive when pursuing fraudulent health insurance claims. Still, they often abuse policyholders and enrolled providers when they feel they can get away without paying. A typical health insurance fraud practice used by many major carriers is targeting a health care provider, usually a small-to-medium medical practice. Typically, the practitioner receives a request from the insurer asking to provide records for a limited number of patients, from 10 to 20. They justify the request by an actual or assumed provision in the provider agreement (in cases it exists). When the providers comply, whether or not they have the authority to make such demands, the carrier’s insurance fraud auditors examine the files, always find some inconsistencies, irregularities, and errors, real or perceived, and determine that the health care provider overbilled the insurer. Then they extrapolate these numbers and apply them to all or most patients of the practice, demanding huge payments in insurance fraud charges. Our insurance fraud attorneys have successfully represented several physicians and medical practices in cases like these, achieving excellent results. We recommend that health care practitioners audited by any carrier speak with a professional team in our New York NY law offices who understand insurance law. Speak with experienced insurance fraud and defense lawyers before submitting documents to insurance fraud investigators and auditors.

We’ve seen a few reasons in our New York City law firm (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 insurance fraud crimes because of financial necessity or because they are just struggling to make ends meet. Others don’t view it as wrong because it’s hard to identify an insurance company as a “victim.” In their mind, robbing a bank is wrong, but taking a claim to which one is not entitled is not necessarily bad.

Under New York Penal Code, insurance fraud can be anything from a Class A Misdemeanor to a Class B Felony. Insurance fraud penalties depend on how much money the insurance carrier lost due to the crime. A conviction can result in prison time in more severe cases involving large amounts of money. You are likely to be deported if you are not a US citizen and the claim is over $10,000. Even if the claim is smaller, you can be deported because insurance fraud is a crime of moral turpitude.

The first thing to remember is not to speak with investigators. If they come to you with questions, you can assume they already know most of the answers. Don’t make it worse by making statements that will incriminate you. 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 New York attorney first, and the criminal defense 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 criminal defense cases where our clients were already arrested, but the outcome was much better than it could have been.

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

FCPA compliance attorneys at Norman Spencer Law Group PC offer their help to Unites States and foreign organizations in developing, implementing and rigorously reviewing their FCPA compliance policies, and in advising their overseas branches, subsidiaries, representatives and agents regarding FCPA-compliant corporate procedures for handling contracts with foreign governments or involving their officials. Besides that, we represent clients investigated and prosecuted by the SEC (Securities and Exchange Commission), FBI and the Dept. of Justice for the Act’s infringement.

The Foreign Corrupt Practices Act regulates the way U.S. companies do business with foreign governments and their officials. It also covers cases of foreign companies implicated in corrupt payments in the U.S. According to this statute, the companies’ representatives must not bribe foreign officials to get profit. Besides that, the legislation makes it illegal to make or offer a bribe to a foreign public official using any kind of interstate communications (mail, electronic, wire). The Act also requires businesses whose securities are listed in the country to comply with certain accounting requirements.

Nowadays the federal government is increasingly aggressively pursuing FCPA violations, and reportedly at any point of time there are around 150 ongoing criminal investigations, a large percentage of which result in prosecutions and convictions.

The SEC has been known to target companies in such investigations by capital origin. Interestingly, China is among the countries viewed by the SEC as presenting a high risk of violations, due to a high level of government corruption. As a result, Chinese companies are one of the most frequently targeted by FCPA enforcement. Besides that, the agency also holds a list of industry domains that statistically are more commonly vulnerable to corruption. These include banking and finance, energy, transportation and some others.

Businesses and persons found guilty of this offense may face severe penalties – prison time, steep fines and forfeiture of property. It should be noted separately that criminal investigations into FCPA violations may uncover other offenses, such as mail and wire fraud, securities and investment related crimes, money laundering and others. Given that the agents may sometimes be overzealous when investigating into FCPA violations allegations, it is highly important to establish policies that will ensure compliance with the Act’s provisions.

Most countries have adopted similar anti-corruption legislation and cooperate with other countries’ governments when investigating into international bribery and corruption cases. Several international organizations help ensure anti-corruption enforcement:

• the Organization of Economic Cooperation and Development;
• the Asia Development Bank;
• the World Bank;
• the United Nations Convention Against Corruption;
• the European Union conventions.

The agreements and conventions signed by these organizations’ state-members provide for harsh criminal penalties, long statutes of limitations and other provisions that help anti-corruption enforcement.

The ultimate goal of FCPA attorneys at our NY firm is to prevent prosecution and criminal investigations through thorough preparation and compliance review. In situations where FCPA investigations have already started, our FCPA lawyers can prevent or minimize the client’s criminal and financial exposure by negotiating alternative methods of resolution.

For example, in a recent case we handled we managed to we managed to negotiate deferred prosecution. In fact, this is not an uncommon outcome in such prosecutions as the government attempts to encourage voluntary disclosure of information and cooperation with federal investigators. In these cases, the corporation may be taking the blame so that its executives avoid criminal charges.

Norman Spencer Law Group has highly competent FCPA attorneys on board who have wide experience building strong compliance programs, conducting internal audits and defending clients in investigations and prosecutions regarding FCPA-related and other white-collar offenses. We assist clients in the U.S. and across the globe in cross-border criminal and regulatory matters. Our FCPA attorneys’ expertise includes issues directly associated with compliance programs, as well as risk assessment, conducting internal investigations concerning potential violations, transaction counseling as to dealing with state-owned entities or other high-risk enterprises, and advice to buyers and sellers regarding FCPA compliance in mergers and acquisitions.

We fully realize the need for discretion involved in these matters, and offer tactful and sensitive solutions to compliance issues confronted by local and foreign companies. We encourage our clients to be proactive in forestalling any potential FCPA issues and assist them in implementing and crafting such measures as formal policy statements, company-wide ethics manuals, training programs and seminars, introducing mechanisms for coordinating/operating the compliance program (“clearinghouse”), maintaining accurate accounting and record-keeping systems, and setting up anonymous reporting procedures.

To obtain a thorough and extensive consultation concerning any FCPA issues your company may face, contact Norman Spencer Law Group PC at (212) 577-6677.