.2406271712021.png)
Criminal cases involving healthcare fraud often make the news. In these cases, doctors,
pharmaceutical representatives, administrators of sober living homes, medical device
distributors, and other professionals in the healthcare industry are accused of making false
statements in order to get money from Medicare, Medicaid, and private health insurance
companies in order to enrich themselves instead of using the money for its intended purpose,
namely providing necessary services for patients.
Health insurance fraud is only one of many kinds of insurance fraud, and it is such a special
case that it counts as a separate criminal offense. Do not assume that you cannot be charged
with insurance fraud just because you do not work in the healthcare industry and do not submit
claims to health insurance companies. Insurance fraud charges can relate to any kind of
insurance if you are accused of making false statements in your capacity as a policyholder or an
employee of an insurance company. If you are facing charges for insurance fraud, contact a
Texas white-collar crime lawyer.
Insurance Fraud Takes Many Forms
Texas Penal Code 35.02 defines insurance fraud as knowingly engaging in fraudulent activities
related to insurance. This is a broad definition that can encompass many actions by insurance
policyholders, sales representatives, and claims adjusters. The following are just a few
examples of actions that can count as insurance fraud:
· Lying about the severity of your injuries or the cost of your medical bills if you get injured
in a car accident
· Intentionally damaging your own property in order to get a payout from an insurance
company, such as by intentionally crashing your car or starting a fire in your house or place of
business
· Selling insurance policies at inflated prices and keeping the money for yourself or paying
kickbacks to accomplices
· Selling counterfeit insurance policies that do not actually provide coverage
· Knowingly making false statements on your application when you purchase an insurance
policy
· Making misleading statements to clients in order to persuade them to buy insurance
policies that they do not need
Defenses to Charges of Insurance Fraud
If you are accused of insurance fraud, your defenses will depend on the nature of the
accusations. For example, if you are accused of intentionally damaging your own property in
order to get an insurance settlement, you can provide evidence that the property damage really
was the result of an accident, as you stated in the insurance claim. If you are accused of making
false statements, you can argue that you reasonably believed that what you were saying was
true so that you acted in good faith and did not have criminal intent. You might also be able to
argue that the prosecution’s interpretation of your statements is not the only plausible
interpretation and does not represent what you meant.
Contact the Law Office of Patrick J. McLain, PLLC About Criminal Defense Cases
A Dallas criminal defense lawyer can help you if you are facing criminal charges for making
false statements on an insurance claim. Contact the Law Office of Patrick J. McLain, PLLC, in
Dallas, Texas, to discuss your case.