Wheeling Insurance Fraud Lawyer

Insurance Fraud Attorney in Wheeling, WV

When accused of insurance fraud, it’s important to understand how insurance fraud laws work and the various defenses for insurance fraud cases. When disasters happen, such as flooding from the Ohio River, it can be tempting to overreport the values of items in our homes or vehicles when submitting claims. If you knowingly or unknowingly commit fraud, a skilled Wheeling, WV, insurance fraud lawyer can review your case and provide options for your defense.

Choose an Insurance Fraud Attorney at Meadows Law PLLC

If you’re facing charges of insurance fraud, having an experienced insurance fraud attorney review your case can help you build a solid defense against the charges. At Meadows Law PLLC, we believe everyone has the right to freedom and personal property.

We have an in-depth understanding of the local laws and years of experience litigating cases just like yours. If you are at risk of losing your freedoms or personal property, we are here to fight for you either through negotiations or in the courtroom.

Overview of Insurance Fraud

Insurance fraud can be committed by an individual against an insurance company, by a business or large organization, an insurance company, or the agent of an insurance company, for personal gain. Insurance fraud is a type of white-collar crime that costs U.S. consumers $308.6 billion annually.

Auto Insurance Fraud

Auto insurance companies lose approximately $29 billion annually to a phenomenon known as premium leakage. Premium leakage is underwriting information that is intentionally omitted or misrepresented to get a more favorable car insurance rate. Different types of omissions and outright fraudulent practices contribute to this amount:

• Unrecognized drivers
• Underestimated mileage
• Accidents and violations
• False garaging
• Title washing
• Counterfeit auto parts

Legitimate car accident claims are also subject to fraud through the overbilling of services never received by victims following an accident. For example, medical professionals may bill insurers for procedures or visits that never occurred, increasing costs for the insurance company through no fault of the insured.

Healthcare Fraud

When visiting the WVU Wheeling Hospital for a routine appointment or emergency medical care, it can be difficult to keep track of every procedure and appointment. Healthcare workers engaging in insurance fraud rely on a hectic environment and overwhelmed patients to succeed in their illegal activities. Financial losses from healthcare fraud may total 3% of total healthcare costs annually, possibly more. The most common types of healthcare fraud include:

• Billing for services not provided
• Billing for more expensive services than those actually provided
• Filing more than one claim
• Billing for services separately instead of bundling them together
• Providing services that were not needed
• Using another person’s insurance to cover treatment

To combat healthcare fraud, fraud-fighting initiatives were included in the 2010 Affordable Care Act and the Improper Payments Elimination and Recovery Act. These protections and initiatives seek to prevent fraud in the following ways:

• Patients seeking treatment are required to provide a photo ID.
• The Department of Health and Human Services (HHS) can remove providers who lie when applying to provide services for Medicare or Medicaid payments.
• Healthcare agencies must conduct audits every three years.
• An Automated Provider Screening system was implemented to review enrollment applications.
• HHS can impose moratoriums on enrolled providers or suppliers.
• The Centers for Medicare and Medicaid can suspend payments to providers and suppliers if they are being investigated for an allegation of fraud.
• Providers or suppliers found guilty of fraud in one area have their service privileges stripped across all areas.

Other Types of Fraud

Insurance fraud can happen within any industry or by any individual. Some other common types of insurance fraud include:

• Workers’ compensation fraud by a business. A business can commit fraud by underreporting payroll, misrepresenting the type of work being completed, or applying for coverage under a different name to secure a lower rate or avoid paying previous claims.
• Workers’ compensation fraud by an employee. An employee can commit fraud by purposefully getting injured or overstating the severity of an injury to claim benefits.
• Opportunistic fraud by an individual. Filing an exaggerated or fabricated claim against an insurance policy after a natural disaster.
• Contractor fraud. Following a natural disaster, contractors target those affected with misleading contracts, forged credentials, requiring payment in full upfront, or by failing to complete the contracted work.

FAQs

What Are Some Common Insurance Fraud Examples?

Some of the most common insurance fraud examples include businesses improperly billing for services that were either not rendered or that were exaggerated, medical practices billing for visits that never occurred or services that were not rendered, faking an injury after a car accident or workplace accident in order to claim benefits, and claiming previously damaged property was damaged during a covered natural disaster.

What Three Elements Must Be Present to Be Considered Insurance Fraud?

The three elements that must be present for a case to be considered insurance fraud are misrepresentation of a situation, direct relation to an insurance claim, application, or policy, and the incorrect information must directly influence the outcome of an application for or claim against an insurance policy. If any of these elements are missing, an action may not be considered insurance fraud.

What Is the Difference Between Soft Fraud and Hard Fraud?

The difference between soft and hard fraud is the circumstances leading to the fraudulent act. Soft fraud is often referred to as opportunistic fraud and refers to fraud committed when an individual exaggerates an otherwise legitimate claim for financial gain. Hard fraud involves careful planning and staging of an event for the purpose of submitting a false claim.

Can You File a Claim Against an Insurance Company in Wheeling, WV for Insurance Fraud?

Yes, you can file a claim against your insurance company in Wheeling, WV if there is a valid reason to suspect fraud has been committed. You can’t file a claim just because you are unhappy. You can file a claim if your insurance claim was denied without a valid reason, for negligence, for bad faith, or for delayed claim processing.

Hire an Insurance Fraud Lawyer From Meadows Law PLLC

If you’ve been accused of insurance fraud or suspect someone is committing insurance fraud against your company, you need to hire an insurance fraud lawyer knowledgeable in insurance fraud laws in West Virginia. Contact Meadows Law PLLC for a confidential consultation.