Insurance Fraud

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Cincinnati Insurance Fraud Lawyer

Helping Individuals in Cincinnati Who have been Charged with Insurance Fraud

Insurance fraud in Cincinnati can involve various types of insurance, including property insurance, health insurance, casualty insurance, disability insurance, and life insurance, to name a few. Sometimes health insurance fraud consists of an internal act, while at other times, it consists of one or more external acts. Internal fraud occurs within the insurance company itself and may involve an insurance company employee who misrepresents one or more facts, in exchange for some form of monetary gain or personal compensation.

In contrast, external acts of insurance fraud normally include acts by insurance policy applicants, third-party claimants, and the policyholders themselves, when they take actions to try and obtain insurance coverage or benefits illegally.

In order for you to ultimately be convicted of insurance fraud, the government must be able to demonstrate, beyond a reasonable doubt, that you knowingly and intentionally committed the fraud. If you are convicted of insurance fraud, you may be facing serious penalties, including fines, jail time, court costs, and other expenses.

The knowledgeable Cincinnati insurance fraud attorneys at the Joslyn Law Firm know and understand the seriousness of insurance fraud charges and have significant experience defending these matters in court. Our experienced team can represent you at all of your legal proceedings and can help you pursue the best possible result in your case and work to minimize potential penalties and other personal and professional consequences.  Please call us today at (513) 399-6289 or contact us online to learn more about how we can help you assert a strong legal defense to your pending criminal insurance fraud charge.

Overview of Insurance Fraud in Ohio 

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Elements of Identity Fraud in Ohio

The elements of identity fraud in Ohio are set out in Ohio’s R.C. Section 2913.49. The prosecutor in an insurance fraud case must prove that the defendant acted with the purpose to defraud or knowing that he or she was facilitating a fraud.

The elements of the first alternative way of proving identity fraud are as followings:

  • The defendant presented to or caused to be presented to an insurer any written or oral statement that is:
    • part of or in support of an application for insurance;
    • a claim for payment on a policy;
    • claim for any benefit on a policy;
  • The defendant knew that the statement or any part of the statement was false or deceptive.

The elements of the second alternative way of proving identity fraud are as followings:

  • With another person the defendant:
    • assisted;
    • aided;
    • abetted;
    • solicited;
    • procured; or
    • conspired;
  • To prepare or make any written or oral oral statement;
  • The statement was intended to be presented to an insurer;
  • The presented state was made as part of or in of an application for insurance, claim for payment, a claim for other benefit of a policy;
  • The Defendant knew that the statement or any part of the statement was false or deceptive.

The standard jury instructions for Insurance fraud under Ohio’s R.C. 2913.47 is found in CR 513.47 for offenses committed on and after July 1, 1996.

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What is Criminal Insurance Fraud in Cincinnati?

Insurance fraud refers to deceptive or false statements or actions intended to get money or benefits from insurance companies that you do not actually deserve. Under Ohio law, insurance fraud can involve deception for any of the following:

  • Supporting an insurance policy application
  • Making a claim for payment
  • Making a claim for other types of benefits from an insurer

There are several types of activities that can lead to a criminal charge of insurance fraud. Some of those activities include the following:

  • Unlawfully inflating an insurance claim in an attempt to try and get a larger benefit payout
  • Unlawfully padding a claim for health insurance
  • Misrepresenting certain aspects of an individual’s personal history with regard to insurance coverage, in an attempt to obtain a lower insurance premium
  • Filing a false claim report in an attempt to obtain insurance benefits unlawfully

When an insurance company believes that an individual filed a false insurance claim for benefits, the insurance company must report that claim to the Ohio Department of Insurance, after which an investigation will likely occur. If the investigation reveals that insurance fraud may have occurred, prosecutors in the State of Ohio can bring charges pursuant to the Ohio Penal Code. If the alleged insurance fraud involves federal law, such as mail fraud or criminal racketeering, the charge may be prosecuted in federal court, and a conviction may lead to incarceration in a federal prison.

Whether you are currently facing state or federal charges for insurance fraud, an experienced Cincinnati insurance fraud attorney can represent you throughout your case and ensure that all of your legal rights remain protected.

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Can an Insurance Fraud Conviction Mean Jail Time?

If you are convicted of insurance fraud, will you go to jail? The answer depends on several factors, though jail time is always a possibility, especially if you do not have the right defense. In Ohio, you can face the following penalties for insurance fraud:

  • First-degree misdemeanor conviction and 12 months in jail if the amount of the alleged fraud is below $1,000
  • Fifth-degree felony conviction and 12 months in jail if the amount of the alleged fraud is between $1,000 and $7,500
  • Fourth-degree felony conviction and 18 months in jail if the amount of the alleged fraud is between $7,500 and $150,000
  • Third-degree felony conviction and 36 months in jail if the amount of the alleged fraud is $150,000 or greater

Federal penalties might be more severe in accordance with the federal sentencing guidelines.

In each case, the accused may be sentenced to jail time, fines, court costs, and other expenses. Moreover, the accused can incur both civil and administrative penalties, including fines, and revocation of a business or professional license, for example.

An experienced Cincinnati insurance fraud attorney can represent you at your sentencing hearing and work to minimize the personal and professional consequences associated with a criminal conviction.

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Definitions under Ohio’s Insurance Fraud Statute

Under Ohio’s insurance fraud statute, the term “defraud” means to knowingly obtain, by deception, some benefit for oneself or another or to knowingly cause, by deception, some detriment to another.

Under R.C. 2913.01(B), the definition of the noun “fraud” is identical to that of the verb “defraud.” The term “insurance policy” is defined to include a policy, certificate, contract, or plan that is issued by an insurer.

“Insurer” means any person that is authorized to engage in the business of insurance in this state under Title XXXIX [39] of the Revised Code, any health insuring corporation, or any other person engaging either directly or indirectly in this state in the business of insurance or entering into contracts substantially amounting to insurance under section 3905.42 of the Revised Code.

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Fraud Unit of Ohio’s Department of Insurance (ODI)

The mission of the ODI’s fraud unit is to investigate suspected insurance fraud and crimes involving insurance in Cincinnati, Hamilton County and throughout the entire State of Ohio. This criminal justice agency investigates complaints of persons suspected of fraudulently attempting to receive a benefit from an insurance company.

Should an investigation find evidence of a crime, the Fraud Unit refers the matter to the appropriate local, state, or federal prosecutor for consideration of criminal charges. The Department of Insurance provides information on indicators of insurance fraud and instructions on how to file a complaint online.

Under Ohio law, each insurer must adopt an anti-fraud program in a written plan to deal with instances of insurance fraud or suspected insurance fraud. If an insurer, as defined in section 3999.42 of the Ohio Revised Code, has a reasonable belief that a person is perpetrating or facilitating an insurance fraud, as established by section 2913.47 of the Ohio Revised Code, or has done so, the insurer must notify the department of insurance.

The Fraud Unit only investigates complaints regarding a consumer or a provider, but not an insurance companies or agents. A complaint against an insurance company goes to the Consumer Service Division and a complaint against an agent goes to the Enforcement Unit. The department encourages people with information about someone committing insurance fraud to call the state’s fraud hotline at 1-800-686-1527.

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Defending against Cincinnati Insurance Fraud Charges

In some cases that involve insurance fraud, the defendant may have the ability to assert a legal defense in response to the criminal charge. In a case involving insurance fraud, for example, the defendant may be able to argue – at trial – that he or she did not harbor the specific intent necessary to commit fraud. The defendant may also be in a position to argue that the alleged insurance fraud was simply an innocent mistake or oversight.

An experienced Cincinnati insurance fraud attorney will be sure to investigate and examine your criminal case from every angle and assert the appropriate legal defense or defenses at the time of your trial.

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Speak with an Experienced Cincinnati Insurance Fraud Attorney Today

A conviction for insurance fraud can result in numerous short and long-term consequences to your personal life and business. If you have been charged with insurance fraud at either the state or the federal level, you should contact the knowledgeable legal team at the Joslyn Law Firm as soon as possible.

Our experienced legal team will make sure that you understand the criminal charge or charges pending against you and can make sure that your legal rights remain safeguarded throughout the entire process. Our team can also make sure that your case has been fully investigated for any constitutional rights violations and may be able to help you formulate and argue a defense. Finally, our team can represent you at your criminal trial and at other legal proceedings, and can advocate for the best possible result in your criminal case.

We help people facing charges in Cincinnati, as well as in Montgomery County, Greene County, Butler County, Warren County, Hamilton County, Brown County, Campbell County, and Clermont County, and throughout Southwest Ohio. To schedule a free case evaluation and legal consultation with a Cincinnati insurance fraud attorney, please call us at (513) 399-6289 or contact us online to learn more about how we could assist you with your legal defense.

  • Brian Joslyn was named Best Lawyer in 2019 by Birdeye.
  • Columbus CEO magazine has yearly selections for the best attorneys in Columbus Ohio. Brian Joslyn has been identified as one of the most highly skilled attorneys across central Ohio.
  • Brian Joslyn has earned recognition for community leadership by Lawyer LegionLawyer Legion
  • Preeminent Attorney Award. Peer rated for highest level of professional excellence.
  • The Better Business Bureau (BBB), founded in 1912, is a private, nonprofit organization whose self-described mission is to focus on advancing marketplace trust.

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