The Basics of Insurance Fraud in Georgia

Consumers are required to purchase several forms of insurance to ensure they are financially protected, such as auto insurance for drivers and home insurance for homeowners. When someone commits an act designed to defraud the insurance process, they are then committing insurance fraud. Insurance fraud is a crime that often comes with serious consequences for the offender. Below we discuss the basics of insurance fraud in Georgia. What Is Insurance Fraud Insurance fraud can be committed by consumers, service providers, insurance companies, or adjusters. The crime is commonly committed by a policyholder or service provider who attempts to claim or obtain an insurance benefit that they are not entitled to. An insurer can also commit fraud by selling fake policies, rate fixing, or denying a valid claim. Types of insurance fraud include automobile, medical and healthcare, life, worker’s compensation, fire, and property. Examples of fraudulent acts include filing fraudulent insurance claims, faking losses, and intentionally causing losses through theft or arson. Georgia Insurance Law Certain types of fraud, such as health care fraud, are considered federal crimes, but the majority of insurance fraud cases are handled at the state and local level. Georgia Code Title 33 states that insurance fraud is committed by any person who knowingly or willfully:

• Makes or aids in the making of any false or fraudulent statement or representation of any material fact or thing in any written statement, in the filing of a claim, in the making of an application, etc.
• Receives money for the purpose of purchasing insurance and converts such money to such person’s own benefit.
• Issues fake or counterfeit insurance policies, certificates of insurance, insurance identification cards, or insurance binders.
• Makes any false or fraudulent representation as to the death or disability of a policy or certificate holder in any written statement or certificate for the purpose of fraudulently obtaining money or benefit from insurer.

In regard to Medicaid fraud, the Georgia State False Claims Act allows whistleblowers to bring a lawsuit in the name of the State of Georgia when someone defrauds the state or local government of its healthcare funds. Georgia law also requires insurance providers to report suspected fraud. Penalty for Insurance Fraud Penalties for insurance fraud can vary widely depending on several factors, including where the fraud occurred and was prosecuted, the amount of money involved, and the criminal history of the defendant. In Georgia, insurance fraud is a felony that carries severe penalties. If found guilty, the defendant can be given anywhere from 2 to 10 years in prison and/or a fine of up to $10,000. The defendant can also be ordered to pay restitution to any victims and possibly face civil penalties. Insurance fraud accusations alone are enough to ruin your career or cause serious life altering consequences. If you are facing such accusations or have been charged with insurance fraud, you should consult with an attorney immediately. A criminal defense attorney with experience in matters of insurance fraud can help you better understand your options and protect your rights. At Andersen, Tate & Carr, our attorneys are dedicated to reaching the best possible outcome for our clients. Our criminal defense attorneys, Patrick McDonough and Trinity Hundredmark, have combined experience of more than 30 years representing clients facing criminal charges in Georgia. For more information, or to request a case evaluation, contact our law office at 1-770-822-0900.