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Insurance Fraud

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Types of Insurance Fraud

Insurance fraud is a dishonest act designed to obtain a benefit, advantage, or money to which the claimant is not entitled. Surprisingly, insurance companies assert that most claims are fraudulent or, at least, exaggerated. This is, however, unlikely, as most people are law abiding and merely want to be compensated fairly. Insurance companies categorize fraudulent claims as “soft fraud” or “hard fraud.” Pursuant to Massachusetts G.L. c. 266 §111A, insurance fraud is punishable by imprisonment for 5 or less years in prison or from 6 months to 2 ½ years in jail, or a fine of $500-$10,000, or both.

If you or a loved one has been accused of insurance fraud, call us at 617-492-0055 to schedule an in-office consultation with Kevin J. Mahoney. As both a prosecutor and lawyer at a large Boston insurance defense firm, Mr. Mahoney gained invaluable insights into the prosecution of individuals for insurance fraud. Let him put that experience to work for you.

Soft & Hard Fraud

“Soft” fraud occurs when the claimant has suffered damages, but misrepresents the extent of the loss to increase his recovery under the insurance policy. A claimant commits “hard” fraud by deliberately manufacturing a situation to enable him to file an insurance claim. Staging a car accident, for example, would constitute “hard” fraud. To recover under a life insurance, some claimants have gone as far as faking their own death. After the family of the “victim” claims the life insurance, a portion or all is sent to the supposed dead person.

Health Insurance Fraud

An individual health care insurance subscriber commits health care insurance fraud by lending his insurance card to a family member or friend who requires medical attention, allowing him to access health care to which he is not entitled. Healthcare providers commit insurance fraud by billing insurance companies for more expensive procedures than were actually performed or by substituting covered procedures for the non-covered procedures actually performed, thereby allowing the healthcare provider to bill the insurance companies under the patients’ insurance policies. Health care providers may also double bill insurance companies for a procedure by re-billing it as different procedure, or by performing unnecessary procedures.

Homeowner Insurance Fraud

Homeowners have engaged in “disaster fraud” schemes. In this type of fraud, homeowners exaggerate or invent false claims, often falsely attributing damage to the home to a storm, such as a hurricane, to recover under a home insurance policy. Where a home requires legitimate repairs, a homeowner, together with a contractor, commit insurance fraud by conspiring to inflate the cost of the repairs, either to divide the proceeds or to satisfy a deductible. Some homeowners falsely claim that expensive items were stolen from the home during a burglary or exaggerate the value of the items stolen.

Automobile Insurance Fraud

Automobile insurance fraud can occur in many ways. Damages to a car may be exaggerated, or totally falsified. One of the most common car insurance fraud schemes is to file false reports for a stolen vehicle, especially where driver fled the scene of an accident. Registering a car in a place where you do not live or listing someone other than the primary driver to lower a premium may constitute auto fraud. Many individuals have staged auto accidents to file false personal injury claims. The conspirators, sometimes including unethical physicians and chiropractors, all profit from the insurance awards. If someone approaches you to participate in one of these stunts, politely decline. Although it may be tempting to recover money from an insurance company, it is not worth the risk of injury, death, or criminal prosecution.

Under Massachusetts G.L. c. 266 §111B automobile insurance fraud is punishable by imprisonment in the state prison for not more than 5 years or by imprisonment in the house of correction for not less than 6 months nor more than 2 1/2 years or by a fine of not less than $1,000 nor more than $10,000, or by both such fine and imprisonment.

Insurance Fraud by Insurance Companies

Insurance companies themselves may also commit insurance fraud by purposely deleting claims from their system, denying coverage for things covered by the policy, or underpaying claims.

Contact a Cambridge Criminal Defense Lawyer

If you have been accused of insurance fraud, call Kevin J. Mahoney, a Massachusetts attorney with more than 25 years of experience. We would be happy to schedule a free in-office consultation for you with Attorney Mahoney.

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Testimonials

  • NS, a DUI client,about 1 month ago

    Attorney Mahoney,

    I just wanted to say thank you for such a wonderful and excellent job you did for me. You were quite impressive up there and you really did your homework catching her in a few lies from previous testimony. You are the best! Even though I never want to be in this situation again, if I know anyone I will give them your name.

    Thank Amy for me too! She is a great asset to have in your office! Very pleasant and understanding.

    Again thank you and go Celtics!
     

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  • about 1 month ago

    Kevin Mahoney recently represented me in a case for destruction of property and disorderly conduct. He was extremely thorough and persistent, and despite a great deal of evidence against me, he managed to get the felony charge dropped without having to go to trial.

    I had never been in legal trouble before and had no idea how to proceed, and without his counsel, I am sure that I would have gotten convicted.

    He listened to my specific needs and always acted in my best interest. His knowledge, attention to detail, and general courtroom presence continued to amaze me throughout the entire process.
     

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  • M.K.about 1 month ago

    Dear Attorney Mahoney:

    I wish to express my sincere appreciation for your efforts on my behalf. Your defense was truly outstanding. The court room skills that you demonstrated and legal knowledge were truly incomparable. I’m wishing you the very best in your future endeavors.

    In addition, I ‘m looking forward to viewing the Jello Trial on Court T.V. Let me thank you once again.

     

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  • about 1 month ago

    Attorney Mahoney,

    Is very knowledgeable and very professional. He has just represented me in a case lasting a year and a half, and he made sure I got a fair trial with a fair jury. He kept me well informed about what would be happening in the court room and always had a well thought out defense for any route of attack the D.A. would be planning on.

    My trial took 2 and a half days and after the jury deliberated for approximately 23 minutes they came back with a “Not guilty” verdict. I would recommend Attorney Mahoney to anyone I know, but I sure hope I dont need him again. : ) .
     

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The Title IX Sexual Harassment Handbook

"Attorney Mahoney is currently authoring an authoritative and strategy driven compendium on investigating and defending Title IX sexual assault cases for lawyers, students, and universities. The book will be available through James Publishing within months."

Practice Areas

  • White Collar Crimes
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  • Insurance Fraud
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