Insurance fraud is prevalent enough that many insurance companies find it worthwhile to commit resources to house a department to investigate fraud. In fact, it’s not unusual for a local prosecutor’s office to have separate units specializing in crimes that involve insurance fraud.
Health care insurance fraud is on the rise. As you know, health care professionals are reimbursed by insurance companies as well as government entities like MediCal and Medicare. Fraud occurs when a health care professional double bills, falsifies medical records and invoices for services that were either not performed at all or unnecessary. Law enforcement will present a warrant to investigate medical records and billing files. Those convicted of health insurance fraud may lose their medical license, be charged steep court fees, and face severe jail or prison sentences.
The Employment Development Department (EDD) in California manages unemployment benefits for out-of-work Californians. The EDD will thoroughly investigate those committing unemployment insurance fraud, which can include individuals submitting claims even though they’ve got income. Unemployment insurance fraud can be committed by an employer who lies about why an employee was discharged to avoid paying unemployment benefits. Those convicted of unemployment insurance fraud will have to reimburse the money paid to them and may face significant jail or prison time. This crime is usually treated as a felony offense.
In California, employers are required to have workers comp insurance in the event that a worker cannot work due to injury while on the job. According to California Insurance Code Section 1871.4, it’s illegal to falsify information and/or make false statements to collect funds from workers compensation insurance. This includes faking an injury, continuing to collect even though the employee is better, and even lying to health care professionals about the injury. Those found guilty of the crime can go to jail/prison and have to repay the defrauded funds.
If you or someone you know is suspected of an insurance crime, drop what you’re doing and contact DRE Law right now. They are staffed with savvy insurance crime defense attorneys who will do what it takes to ensure you are not denied justice.
