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What is insurance fraud?

When an accused individual has been charged with insurance fraud or is facing other fraud charges, they may wonder exactly what they are being accused of. The most basic definition of insurance fraud is when an insured individual has been accused of making a false or exaggerated insurance claim for losses or injuries they allegedly did not suffer.

Insurance fraud refers to a deceptive act designed to obtain an improper insurance payment from an insurer. In general, fraud refers to deceptive or misleading acts that are intended to obtain an unfair benefit for personal gain. The elements of fraud charges authorities must prove include knowingly making a false or misleading statement; the false or misleading statement is made in connection with a claim or payment; and the statement made is material in that it would impact the outcome of the claim.

Different types of insurance fraud can include false claims, using another's identity to obtain healthcare benefits; or inflated billing by a medical care provider for services that were not provided. Serious insurance fraud charges can include making a claim for an accident, injury, theft, arson or other loss that did not actually occur. Other types of fraud might include what are considered innocent lies to insurers for which no serious criminal action may be taken.

When facing any fraud charges, including insurance fraud charges, it is important to have a strong criminal defense. A strong criminal defense strategy can help the accused individual fight the charges and accusations they are facing which could otherwise lead to serious potential penalties and consequences for them.

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