Understanding What Counts as Insurance Fraud Most people who own motor vehicles or businesses rely on insurance in case an unexpected accident occurs. Unfortunately, some people attempt to fraudulently use insurance in cases for which coverage does not apply. Other times, people end up charged with insurance fraud when they did not do anything illegal… Read More
In criminal law, both at the state and federal levels, there are many possible crimes that can be considered fraud—wire fraud, mail fraud, tax fraud and healthcare fraud, for example. But what constitutes fraud in the eyes of the law? How do prosecutors decide when fraud has actually been committed, and how do they go… Read More
In October 2014, three women from the Tallahassee area were arrested on suspicion of Medicaid fraud, claiming tens of thousands of dollars in benefits for services that were never rendered. According to an investigation by Attorney General Pam Bondi’s Medicaid Fraud Control Unit (MFCU), two Tallahassee women (Melissa L. Simmons, 39, and Felicia S. Simmons,… Read More
Anyone who has tried to decipher a hospital bill or an insurance company’s explanation of benefits can attest to how complicated our system of paying for health care can be. Determining what portions will be covered by what entities depends on the physician network, insurance plan and the specific billing code for the procedure. When… Read More
The Healthcare industry is a heavily regulated and complex business. It is rare now for doctors to receive the full payment for their services directly from their patients. Rather, a complex system involving insurance companies, HMOs, and federal and state agencies are all part of the payment process. On Wednesday, an Atlanta doctor was sentenced… Read More
As the recent mistrial in the Roger Clemens case demonstrates, prosecutors must obey the rules of evidence. When prosecutors violate a judge’s order or the rules of evidence, a defendant is often unfairly harmed as a result. However, not every violation of evidence rules results in a mistrial. On some occasions, juries can be unfairly… Read More
In August 2009, a commercial fishing boat called the Alexander II set out from Cape May, New Jersey, and was reportedly making good progress. The ship’s log showed that the fishermen had caught more than 50 fish with a total weight of 3,000 pounds. About 86 miles from the coast, the boat began taking on… Read More
The National Insurance Crime Bureau (NICB), an insurance industry group, collects nationwide data about questionable insurance claims from its member insurance companies in an effort to estimate the rate and types of insurance fraud occurring in the U.S. In its latest analysis released today, the NICB estimates that property, casualty, commercial, workers’ comp and miscellaneous… Read More
A 29-year-old Nashville man has been indicted by a federal grand jury in Atlanta for insurance fraud, Medicare and Medicaid fraud, and other crimes for impersonating a doctor and for persuading doctors in both Georgia in Tennessee to help him falsely bill Medicare, Medicaid and private insurance companies for medical services. He is said to… Read More
An account manager for United Health Care in Tampa, Florida, was the target of a year-long criminal investigation after she was suspected of staging a car accident and pretending to be injured in order to obtain insurance money. The 36-year-old woman has been charged with insurance fraud and is being held in a Hillsborough County… Read More