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Insurance Fraud In Florida: What You Need To Know

Insurance fraud in Florida is perennially a major concern, and scores of Floridians find themselves charged with insurance fraud in Florida courts. What follows is a brief synopsis of insurance fraud laws in Florida and what you need to know if you find yourself charged with insurance fraud.

Basics

Insurance fraud in Florida is the act of submitting an insurance claim that is

  • false,
  • exaggerated, or
  • based on a deliberate injury or loss.

In general, submitting false or misleading information when making an insurance claim can be grounds for a charge of insurance fraud.

Professionals Committing Insurance Fraud

In Florida, individuals in certain professions have different requirements when submitting insurance claims. Professionals with different requirements include

  • physicians,
  • osteopathic physicians,
  • chiropractic physicians, and
  • practitioners.

Such physicians are prohibited from intentionally conspiring with others to commit insurance fraud, benefit from insurance fraud, or urge another who is covered by insurance to commit insurance fraud. In addition to criminal consequences, those licensed professionals are also likely to face punishment from Florida’s Board of Medicine, the Board of Osteopathic Medicine, or the Board of Chiropractic Medicine, depending upon which body has previously licensed them to practice in Florida.

Similarly, attorneys in Florida are forbidden from benefiting from insurance fraud, and they are also likely to face administrative proceedings by the Florida bar.

Hospital Administrators

Individuals and government entities that are licensed in Florida to maintain or operate a hospital are prohibited from benefiting from fraudulent claims on insurance policies as well. Hospital administrators who knowingly allow their facilities to be used in insurance fraud schemes are subject to penalty in Florida, and a conviction for insurance fraud or a pattern of business practices that violate the spirit of the laws against insurance fraud in Florida may lead to the state suspending or revoking their license to operate a hospital. Hospital administrators may also be fined up to $5,000 as well.

Penalties

The penalties for insurance fraud in Florida vary depending upon the amount of fraud involved, but in all cases a conviction for insurance fraud is a felony.

  • If the fraud involved is less than $20,000, a conviction is a third degree felony, punishable by up to five years in prison and a fine of up to $5,000.
  • If the fraud involved is between $20,000 and $100,000, a conviction is a second degree felony, punishable by up to ten years in prison and a fine of up to $10,000.
  • If the fraud involved is over $100,000, the conviction is a first degree felony, punishable by up to fifteen years in prison and a fine of up to $15,000.

However, some exceptions to these penalties are in the statute. If the insurance fraud involves intentionally causing a vehicle crash, a conviction is a second degree felony with a minimum prison sentence of two years.

Soliciting individuals involved in a motor accident offering to help them in taking legal action also falls under the insurance fraud statute, and a conviction is a second degree felony with a minimum prison sentence of two years.

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