Insurance Fraud

At Hager & Schwartz, P.A., we recognize how overwhelming this situation can be. Our insurance fraud lawyers are former state prosecutors with over 50 years of combined experience. We have been on the other side of the courtroom and understand how the government builds its case. That insight helps us develop a strong, personalized defense strategy focused on identifying weaknesses in the prosecution’s claims and protecting your rights at every stage.

If you’re facing insurance fraud charges in Fort Lauderdale or suspect you may be under investigation, time is critical. Let us help you understand your options. Contact our office to schedule a free, confidential consultation.

Common Types of Insurance Fraud

Insurance fraud can take many forms, but at its core, it involves intentionally misleading an insurance company to gain benefits or compensation you’re not entitled to. These cases often arise from complex, high-pressure situations, where misunderstanding, miscommunication, or desperation may play a role. Regardless of intent, being accused of fraud can quickly escalate into a felony charge with serious consequences.

Some of the most common types of insurance fraud include the following:

• Arson for insurance money: Deliberately setting fire to a home, vehicle, or property to collect insurance proceeds.
• Staged auto accidents: Coordinating a collision, often involving multiple participants, to submit claims for vehicle damage or personal injury.
• False or exaggerated claims: Inflating the value of damaged items, faking injuries, or submitting claims for events that never happened.
• Submitting fake or inflated invoices: Using fraudulent receipts or bills to boost the payout on a legitimate claim, or to support a fabricated one.
• Misrepresentation on applications: Lying or omitting important information (such as health history or property conditions) when applying for insurance coverage.
• Withholding benefits from rightful recipients: Preventing others from accessing benefits they are entitled to, often by concealing facts or manipulating documentation.

Types of Policies Involved

Insurance fraud can occur across nearly all types of policies.

Here are some of the most commonly targeted:

• Auto insurance: Including staged collisions, fake injury claims, or exaggerated repair costs.
• Homeowners insurance: False claims related to storms, theft, fire, or other property damage.
• Life insurance: Misrepresenting medical history on applications or submitting false claims involving identity fraud or staged deaths.
• Healthcare insurance: Billing for services never provided or using someone else’s policy information.
• Property insurance: Filing claims for non-existent or pre-existing damage to commercial or personal property.
• Workers’ compensation: Claiming an injury that didn’t occur at work or exaggerating its severity to remain on leave.
• Renter’s or travel insurance: Inflated or fabricated claims for lost, stolen, or damaged items while traveling or renting.

If you’re under investigation or charged with any form of insurance fraud, it’s vital to have legal representation that understands the legal and human aspects of your case. Our attorneys don’t just focus on the charges. We consider the entire story. Let us help you move forward confidently.

How Insurance Fraud Is Investigated

Insurance fraud investigations in Florida are extensive and aggressive, often involving state and federal agencies, depending on the scope of the alleged offense. What may begin as a single suspicious claim can quickly grow into a comprehensive inquiry with forensic specialists, government investigators, and law enforcement. If you’re under investigation, it’s not just about what you did or didn’t do. It’s about how the evidence is interpreted. Without proper legal defense, that interpretation can swiftly turn against you.

State-Level Investigations

In Florida, most cases of insurance fraud fall under the jurisdiction of the Bureau of Insurance Fraud, which operates within the Florida Department of Financial Services (DFS). This specialized unit investigates alleged violations of Florida Statutes § 817.234, a law that outlines various prohibited actions, such as making false statements in support of a claim or intentionally concealing information from an insurer.

This division is often the first to respond when red flags are raised. Investigators may conduct interviews, issue subpoenas, and collaborate with insurers to gather documentation related to the claim. They also work closely with local prosecutors to decide whether to file formal charges.

When Federal Authorities Step In

If the alleged fraud involves a large-scale scheme, crosses state lines, or impacts companies engaged in interstate or international commerce, the case may be referred to federal authorities. Agencies such as the FBI and the Department of Justice (DOJ) often become involved in these cases, and charges might be filed under 18 U.S.C. § 1033, a federal law that criminalizes fraudulent activities involving insurance companies operating across state or national borders.

Federal investigations are typically more resource-intensive and can carry stiffer penalties upon conviction, making early legal intervention essential.

Investigative Tactics

Whether at the state or federal level, investigators often use a combination of tactics to build their case.

These methods include:

• Forensic accounting: Examining financial records to detect inconsistencies or uncover hidden assets.
• Surveillance: Monitoring suspects to confirm or disprove injury claims or behavior inconsistent with the alleged fraud.
• Witness interviews: Speaking with employers, healthcare providers, adjusters, or others connected to the claim.
• Data analytics and pattern recognition: Identifying trends that suggest organized or repeated fraudulent behavior.

What Triggers an Investigation?

Many insurance fraud investigations begin with a tip-off—often from an insurance company, a coworker, or someone familiar with the claim.

Others are triggered by suspicious claim activity, such as:

• Filing multiple claims in a short timeframe
• Inconsistencies between reported events and physical evidence
• Exaggerated losses that don’t match documented damage
• Use of the same repair or medical providers across unrelated claims

If you suspect you’re under investigation for insurance fraud, act now. We understand investigators’ tactics because we’ve worked with them in our previous roles as state prosecutors. Our defense starts with understanding the facts and predicting how the prosecution might build its case. From there, we develop strategies to counter their efforts and defend your rights.

What Are the Penalties for Insurance Fraud?

Insurance fraud is a serious crime. It’s a felony under Florida law, and the consequences can be life-changing. From heavy fines and lengthy prison sentences to the long-lasting effects of a criminal record, a conviction can impact almost every aspect of your life, including your employment, finances, and future prospects. The seriousness of the charges largely depends on the details of the case, especially the value of the alleged fraudulent claim and whether violence or organized schemes were involved.

Felony Classifications in Florida

In Florida, insurance fraud is charged as a felony.

The penalties increase based on the amount of the fraudulent claim:

• Third-degree felony:

• • • Value under $20,000
    • Penalties: Up to 5 years in prison, 5 years of probation, and a fine of up to $5,000
    • Second-degree felony:
    • • • Value between $20,000 and $99,999
        • Penalties: Up to 15 years in prison, 15 years of probation, and a fine of up to $10,000
        • First-degree felony:
        • • Value of $100,000 or more
          • Penalties: Up to 30 years in prison, and a fine of up to $10,000

          Additionally, aggravating factors may increase the severity of charges or trigger separate counts.

          Federal Penalties

          When insurance fraud crosses state lines or involves companies operating in interstate commerce, it may also lead to federal charges under statutes like 18 U.S.C. § 1033.

          Federal penalties include:

          • Up to 10 years in federal prison
          • Up to 15 years if the fraud endangered the financial stability of an insurer
          • Additional fines, restitution, and supervised release

          Federal convictions can also lead to harsher sentences if the defendant was previously convicted for a similar crime or if the fraud targeted vulnerable groups like the elderly.

          We understand what’s at stake when you’re facing felony charges. Our Fort Lauderdale defense attorneys bring decades of combined experience to craft strong, strategic defenses. We carefully review every detail, from the specifics of the alleged fraud to how the investigation was conducted, to fight for reduced charges, minimized penalties, or complete dismissal when possible.

          Strategic Defense for Insurance Fraud Allegations

          When you’re facing insurance fraud allegations, your choice of defense strategy and how early you act can affect the outcome of your case. Every charge has a unique story behind it. Our role is to uncover that story, challenge the state’s assumptions, and safeguard your rights at every stage of the legal process.

          The earlier you involve a defense attorney, the more control you have over your case. Acting early lets us work with investigators before charges are filed, preserve key evidence, and create a defense strategy challenging the prosecution’s case. Waiting until you’re in court can restrict your options and make it harder to build an effective defense.

          No two insurance fraud cases are exactly alike, which is why we don’t take a one-size-fits-all approach.

          Our attorneys draw from more than five decades of combined legal experience to assess cases from every angle and pursue defenses such as:

          • Lack of intent to defraud: Many fraud charges hinge on the allegation that you knowingly misled an insurer. But in many cases, mistakes happen without any intent to deceive.
          • Clerical or reporting error: Honest miscommunications or documentation mistakes can be misinterpreted as fraud, especially in complex claims.
          • Insufficient evidence: The prosecution must prove every element of the case beyond a reasonable doubt. If they can’t, the charges may not hold.
          • Entrapment or unlawful investigation: If law enforcement violated your rights or coerced you into making incriminating statements, we will challenge the validity of their actions in court.

          Building Your Case with Experts and Evidence

          A strong defense often relies on facts that support your position. We collaborate with expert witnesses, such as insurance specialists, accountants, and medical professionals, to challenge the prosecution’s assertions. Additionally, we assist clients in collecting relevant documentation—emails, claims forms, financial records—that offer context and clarity regarding the alleged fraud.

          Our attorneys are former prosecutors who understand how the state builds its case and how to identify its weak points. We don’t reuse defenses from one case to another. Instead, we develop customized legal strategies tailored to your circumstances and charges.

          Under Investigation for Insurance Fraud? Contact an Attorney.

          If you think you’re under investigation for insurance fraud—even if no charges have been filed yet—it’s crucial to seek legal advice immediately. At this early stage, your future is still uncertain, and what you do (or don’t do) next can influence the outcome of your case.

          The earlier our insurance fraud attorneys at Hager & Schwartz, P.A. get involved, the better we can protect you. From the moment investigators start making inquiries, whether it’s a request for documents, a subpoena, or a phone call asking for an “informal chat,” they’re already building a case. You don’t have to face this alone.

          If you’re suspected of insurance fraud, our experienced white collar crime attorneys are prepared to fight for you. Contact us to schedule a confidential consultation.

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