NYC Insurance Fraud Lawyer

Insurance fraud is the crime of using a false statement, a staged event, or a fabricated or inflated claim to obtain an insurance payment you are not entitled to, and in New York City it can be charged as a serious federal offense, a state felony, or both at the same time. Prosecutors treat insurance fraud aggressively, from no-fault auto and staged-accident rings to health care billing, workers compensation, disability, property, and life insurance claims. Because these cases turn on proving intent to deceive, they are frequently defensible, but only with the right lawyer and an early start. If you are under investigation or charged, an experienced insurance fraud attorney should be your first call.

Varghese & Associates, P.C. is a federal criminal defense firm on Wall Street, in the heart of the Southern District of New York. Insurance fraud is a core part of our federal fraud defense practice, and the firm is led by Vinoo Varghese, a former prosecutor and one of the most recognized criminal defense attorneys in the country. Our insurance fraud attorneys handle these cases in house, from the first subpoena or contact through investigation, indictment, trial, sentencing, and appeal. Matters are not routed out to other firms.

Call now for a confidential consultation with a New York City insurance fraud lawyer. The earlier our insurance fraud defense lawyers are involved, the more they can do.

What Is Insurance Fraud?

Insurance fraud is any act intended to obtain an improper payment from an insurer, whether by filing a false or exaggerated claim, staging a loss, misrepresenting information on an application, or billing for services that were never provided. It can be committed by a policyholder, a claimant, a medical provider, a business, or someone inside the insurance industry. The defining element is intent to deceive, meaning the government or the state must prove you knowingly set out to defraud the insurer, not that you made an honest mistake or a good-faith error on a claim. That intent requirement is where an experienced insurance fraud attorney focuses the defense.

Is Insurance Fraud a Federal or a New York State Crime?

Insurance fraud can be charged as either a federal crime or a New York State crime, and serious cases are often charged as both. At the federal level, insurance fraud is usually prosecuted through the mail fraud, wire fraud, and health care fraud statutes, and through the federal insurance-fraud statute that reaches conduct affecting interstate commerce. Under New York law, insurance fraud is its own offense under Penal Law Article 176, graded by the dollar amount involved. Which system charges a case depends on the facts, the amount, and whether federal programs, interstate wires, or the mail were involved. Because the exposure and the strategy differ, it matters that your lawyer is comfortable defending insurance fraud in both federal and New York courts.

What Are Examples of Insurance Fraud?

Common examples of insurance fraud include staged or caused auto accidents, no-fault auto insurance schemes, inflated or fabricated property and casualty claims, arson for insurance proceeds, false or padded medical billing, workers compensation and disability fraud, and misrepresentations on an insurance application. In New York City, no-fault auto insurance fraud and health care billing schemes are especially heavily investigated, often involving clinics, medical providers, and networks of participants. In practice, insurance fraud is rarely charged alone. Prosecutors frequently pair it with mail fraud, wire fraud, health care fraud, grand larceny, and money laundering, stacking counts to increase both the pressure and the potential sentence.

Insurance Fraud and Related Charges, and the Statutes Behind Them

An insurance fraud case usually comes with companion charges, and which statutes are in play matters, because each has its own elements and penalties. The charges most often filed in insurance fraud cases include:

• Federal insurance fraud affecting interstate commerce (18 U.S.C. §§ 1033 and 1034)
• Mail fraud, for claims or documents sent by mail (18 U.S.C. § 1341)
• Wire fraud, for claims submitted electronically (18 U.S.C. § 1343)
• Health care fraud, for medical billing schemes (18 U.S.C. § 1347)
• False statements and conspiracy (18 U.S.C. §§ 1001, 371, and 1349)
• New York insurance fraud in the first through fifth degrees (N.Y. Penal Law Article 176)
• New York falsifying business records and scheme to defraud (N.Y. Penal Law §§ 175.10 and 190.65)
• Grand larceny and money laundering of the alleged proceeds (N.Y. Penal Law Article 155; 18 U.S.C. §§ 1956 and 1957)

What Are the Penalties for Insurance Fraud?

Penalties for insurance fraud depend on the amount involved and whether the case is federal or state, but they are severe: federal fraud counts carry up to 20 years in prison each, and New York insurance fraud is graded from a misdemeanor up to a class B felony punishable by years in state prison, along with fines, restitution, and forfeiture. Under New York Penal Law Article 176, the degree of the offense rises with the value of the fraud, so the dollar amount drives the exposure. On the federal side, each mailing, wire, or claim can be charged as a separate count, multiplying the potential sentence. The severity of these penalties is exactly why an experienced insurance fraud attorney should be involved as early as possible.

How Does Sentencing Work in an Insurance Fraud Case?

In federal insurance fraud cases, sentences are calculated under the United States Sentencing Guidelines, where the biggest driver is the dollar amount of the intended or actual loss, while New York cases are graded directly by the value of the fraud under Penal Law Article 176. In both systems, the amount at stake controls much of the outcome, which is why contesting how loss or value is calculated is one of the most valuable fights in an insurance fraud case. Our insurance fraud attorneys challenge the loss and value calculations, contest enhancements, present detailed mitigation, and argue for the lowest possible sentence, and in appropriate cases for a non-custodial resolution.

What Are the Defenses to an Insurance Fraud Charge?

Insurance fraud turns on intent, and that is where the defenses concentrate. Every case is different, but the strategies our insurance fraud lawyers commonly use include:

• No intent to defraud. Insurance fraud requires a knowing, willful intent to deceive the insurer. An honest mistake, a good-faith claim, or a genuine dispute over coverage is not fraud.
• A legitimate claim or loss. Where the accident, injury, or loss was real, an aggressive or disputed claim is not a crime.
• No material misrepresentation. The government or the state must prove a material false statement, not a minor or immaterial discrepancy.
• Attacking the loss or value calculation. Forensic and medical analysis can show the claimed amount was inflated by the government, not by the defendant.
• Insufficient proof of participation. In staged-accident and clinic cases, mere association with others is not proof that you knowingly joined a scheme.
• Suppression. Where records were obtained through an unlawful search, subpoena, or seizure, our attorneys move to suppress under the Fourth Amendment.

What Should You Do If You Are Under Investigation for Insurance Fraud?

If you learn you are under investigation for insurance fraud, do not talk to investigators or an insurance company's special investigations unit, do not give a recorded statement, and do not alter, delete, or destroy any records. Call an insurance fraud attorney immediately. Anything you say, including to your own insurer, can be used against you, and insurance companies routinely refer suspected fraud to prosecutors. You have the right to remain silent and the right to counsel. Preserve everything, say nothing without counsel, and let your lawyer engage the investigators and prosecutors.

How Our Insurance Fraud Attorneys Can Help You

Our insurance fraud defense lawyers defend these cases at every stage, and they look for the earliest possible point at which the case can be won or shrunk:

• Early intervention. Responding to subpoenas, target letters, and special-investigations-unit inquiries, handling proffers, and negotiating with prosecutors to seek a declination or reduced charges before an indictment is filed.
• Investigation and evidence challenges. Independently investigating the facts, testing the government's evidence, and filing suppression motions where evidence was unlawfully obtained.
• Motion practice. Moving to dismiss defective counts, limiting the government's proof, and litigating the admissibility of records and expert testimony.
• Trial. Trying cases before federal and New York judges and juries, which is exactly why the firm prepares every case for trial from the start.
• Sentencing and mitigation. Challenging the loss and value calculations, arguing for variances or the lowest applicable grade, and defending against restitution and forfeiture.
• Appeals and post-conviction relief. Direct appeals and post-conviction motions where the law and the record support them.

Is Insurance Fraud a Felony?

Insurance fraud is usually a felony when the amount involved is significant, though small New York cases can be charged as a misdemeanor. Under New York Penal Law Article 176, insurance fraud in the fifth degree is a misdemeanor, while higher degrees, tied to larger dollar amounts, are felonies rising to a class B felony. Federal insurance fraud charged through the mail, wire, or health care fraud statutes is always a felony. Because even a mid-level case can bring prison exposure, every insurance fraud allegation should be treated as serious from the start.

Can an Insurance Fraud Charge Be Dismissed Before Trial?

Yes. An insurance fraud charge can be dismissed or reduced before trial through a motion to dismiss a legally defective charge, a successful suppression motion that removes key evidence, or negotiation that leads the prosecutor to drop or lower the charges. Because these cases depend on proving intent and on detailed claim and billing records, they are often more vulnerable than they first appear. Dismissals are never guaranteed, but they are far more likely when an insurance fraud attorney is involved early and challenges the case before it hardens.

How Much Does It Cost to Hire an Insurance Fraud Lawyer in New York City?

The cost of an insurance fraud lawyer in New York City depends on whether the case is federal or state, the complexity of the alleged scheme, the volume of claim and billing records, and whether the case resolves before or goes to trial. Insurance fraud cases involve extensive record review, forensic and sometimes medical analysis, and detailed motion practice, so they require real work. Our insurance fraud attorneys are transparent about fees from the first conversation and structure the representation to fit the matter. Given the prison exposure and restitution at stake, the more important question is usually what an inadequate defense can cost you.

An Insurance Fraud Attorney the National Media Turns To

When the biggest federal cases in the country are in the news, networks and newspapers call Vinoo Varghese to explain what is really happening in the courtroom. That is the same judgment and credibility our insurance fraud attorneys bring to your case.

Vinoo Varghese has provided legal analysis and commentary for CBS News, Fox News, Fox Business, CNN, MSNBC, Court TV, HLN, BBC, Inside Edition, i24 News, Sky News Arabia, and Nancy Grace's Crime Stories, and has hosted true-crime legal analysis for Vanity Fair. He has been quoted as a legal authority by The New York Times, The Wall Street Journal, the New York Law Journal, Law360, the New York Daily News, and the New York Post. A former prosecutor from the Brooklyn District Attorney's Office, he is a nine-time National Trial Lawyers Top 100 honoree, an eight-time New York Metro Super Lawyer, rated AV Preeminent by Martindale-Hubbell, and has served on the visiting faculty of Harvard Law School's Trial Advocacy Workshop.

Contact a New York City Insurance Fraud Lawyer Now

If you are under investigation, have received a subpoena or target letter, or have been charged with insurance fraud anywhere in New York City, do not wait and do not talk to anyone but your lawyer. Insurance fraud is part of our broader federal fraud defense practice, and an insurance fraud attorney who has stood in the courtroom and tried the cases can change what happens next.

Call Varghese & Associates, P.C. for a confidential consultation. Our office is located at 2 Wall Street, Suite 310, New York, NY 10005, steps from the federal courthouses of the Southern District of New York.