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Insurance Fraud

Insurance fraud is criminalized under Section 5/17.10-5 of of the Illinois Criminal Code, which states that fraud occurs when a person “knowingly obtains…by deception, control over the property of an insurance company or self‑insured entity by the making of a false claim.” In addition, the person must have an intention to permanently deprive the insurance company of their property. Insurance of all kinds are covered by the law, including health, life, car, and property insurance.

Penalties for Committing a Fraudulent Act

Violating this part of the criminal code carries sanctions that vary depending on the amount of funds fraudulently obtained:

  • For less than $300, an offense in considered a Class A misdemeanor.
  • For more than $300 but less than $10,000, an offense is a Class 3 felony.
  • For more than $10,000 but less than $100,000, a violation will be classified as a Class 2 felony.
  • For more than $100,000, it is considered a Class 1 felony.

In addition to seeking out individual perpetrators of insurance fraud, Illinois’ Insurance Claims Fraud Prevention Act also targets healthcare providers by making it unlawful to procure patients or services through fraudulent means. Specifically, the act states that it is “unlawful to knowingly offer or pay any remuneration directly or indirectly, in cash or in kind, to induce any person to procure clients or patients to obtain services or benefits under a contract of insurance or that will be the basis for a claim against an insured person or the person’s insurer.” If convicted of insurance fraud under this statute, an individual could face a civil penalty of $5,000 to $10,000, as well as an assessment of up to three times the amount of each fraudulent claim. Medicare and Medicaid fraud, involving the filing of insurance claims to the federal government on the basis of beefed-up or nonexistent services, are common forms of insurance fraud.

Defenses to Allegations of Insurance Fraud

Prosecutors must prove that an alleged perpetrator of insurance fraud knew that they were making a false claim, and that they intended to derive funds from an insurance company as a result. Because of this requirement, honest mistakes made in the midst of excessively complicated healthcare systems are not the target of these laws. Lack of knowledge of the mistake can serve as valid defense to allegations of insurance fraud.

An aggressive attorney can help you plan a strong defense if you are facing allegations of insurance fraud of any kind. Goldman & Associates is well-versed at representing clients accused of insurance fraud and other white collar crimes in the Chicago area. Contact our office today for a free consultation on your Illinois insurance fraud case.

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