Insurance Fraud Defense Lawyers

Insurance fraud committed by and against insurance companies is a federal offense that can lead to criminal prosecution by the U.S. Department of Justice (DOJ). Our firm represents individuals and businesses accused of insurance fraud nationwide.

The insurance industry is among the most heavily-regulated industries in the United States. Federal laws and regulations establish protections for policyholders and third-party claimants, and they establish protections for insurance companies as well. Each year, fraudulent claims cost insurance companies tens of billions of dollars; and, according to the Federal Bureau of Investigation (FBI), this translates to hundreds of extra dollars per year in premiums for American families. Businesses also pay far more for insurance as a result of the prevalence of fraud, and federal authorities closely scrutinize allegations of fraud on both sides of insurance claims and transactions.

At Oberheiden P.C., our federal criminal defense attorneys represent individuals and companies nationwide in insurance fraud matters. With potential penalties including hundreds of thousands or millions of dollars in fines and a decade or more of federal imprisonment, all allegations of insurance fraud need to be taken seriously. We defend individuals and companies during investigations, grand jury proceedings, and criminal trials, and our experience includes securing favorable results in matters involving the DOJ, FBI, and numerous other federal law enforcement agencies.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

John W. Sellers
John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena
Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (OIG)

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz

Former Supervisory Special Agent (FBI)

Chris Quick
Chris Quick

Former Special Agent (FBI & IRS-CI)

Kevin M. Sheridan
Kevin M. Sheridan

Former Special Agent (FBI)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Dennis A. Wichern
Dennis A. Wichern

Former Special Agent-in-Charge (DEA)

Insurance Fraud: Defense of Individuals and Corporate Policyholders

While insurance fraud perpetrated by insurance applicants, policyholders, and third-party claimants can lead to civil liability in private litigation, it has the potential to lead to federal law enforcement action as well. Federal authorities are on high alert for allegations of insurance fraud, and DOJ prosecutors can use a variety of different statutes to pursue criminal charges. We handle matters including:

  • Healthcare Insurance Fraud – The tens of billions of dollars in annual losses that the FBI attributes to insurance fraud does not include fraud in the healthcare sector. Some estimates put the cost of healthcare insurance fraud in the hundreds of billions of dollars per year. We represent policyholders and providers accused of fraudulently seeking coverage from private insurers as well as from Medicare, Medicaid, and other federal benefit programs.
  • Life Insurance Fraud – Life insurance fraud can take many forms; and, while many cases involve legitimate coverage disputes, allegations of fraudulent life insurance claims are common. We represent policyholders and beneficiaries in life insurance fraud litigation and law enforcement proceedings involving alleged fraudulent representations and omissions on life insurance applications as well as alleged fraudulent claims for coverage.
  • Auto and Home, Fire, and Flood Insurance Fraud – Auto, home, fire, and flood insurance fraud are commonly targeted in federal law enforcement proceedings as well. This is particularly true in cases involving claims for significant property damage and claims involving catastrophic injury or death. Similar to life insurance, while there are often legitimate justifications for policyholders’ and third-party claimants’ claims, individuals and businesses will often find themselves facing allegations of criminal insurance fraud.
  • Business Insurance Fraud – Due to the dollar amounts involved, a significant number of federal insurance fraud enforcement matters involve commercial liability, general liability, business interruption, umbrella, and other business insurance policies. Businesses accused of defrauding their insurance companies in order to secure coverage or obtain payment can face steep penalties, and in many cases individual business owners and executives can be personally at risk for criminal prosecution. Our federal criminal defense attorneys and former federal agents have extensive experience investigating insurance claims, and we can use this experience to protect you and your company against federal liability.
  • Reinsurance and Other Insurance Fraud Matters – Our attorneys and former agents are also available to represent companies in reinsurance fraud and other complex insurance fraud matters. With centuries of combined experience in federal defense practice, and with particular experience in the insurance field, we are able to quickly assess our clients’ exposure (if any) and present strategic defenses that are tailored to the specific legal and factual issues at hand.

In these and other cases, our defense attorneys and former federal agents provide advice and representation throughout the duration of the government’s inquiry. If the government’s investigation is still ongoing (i.e. if you have recently received a subpoena, search warrant, or criminal complaint), our attorneys will work diligently to secure a favorable pre-charge resolution. If you have already been charged or indicted, we will focus our efforts on getting your charges dismissed (or negotiating a favorable plea deal, if necessary) without going to trial.

Insurance Fraud: Defense of Providers and Contractors

We represent healthcare providers, construction contractors, and other suppliers in federal insurance fraud cases as well. A significant portion of our practice in this area is devoted to the healthcare arena, where we represent physicians, physician groups, hospitals, clinics, laboratories, pharmacies, and other providers accused of federal healthcare fraud. We also represent contractors accused of bid rigging, falsely inflating repair costs, substituting inferior materials, and other types of fraud, including allegations arising out of disaster response efforts and other large-scale casualty events.

Insurance Fraud: Defense of Insurance Company Insiders

In addition to representing policyholders, third-party claimants, providers, and contractors, we represent insurance company insiders who are accused of engaging in fraudulent conduct. Frequently, these cases will involve allegations under 18 U.S.C. Section 1033. This statute contains a number of prohibitions, and insurance company insiders can face criminal prosecution for offenses including:

  • Embezzlement, abstraction, purloining, and misappropriation of insurance company funds, insurance premiums, and insurance credits;
  • Knowingly making any false entry of material fact in any book, report, or statement with the intent to deceive;
  • Making fraudulent representations to any federal or state agency that regulates insurance companies; and,
  • Corruptly influencing, obstructing, or impeding the “due and proper administration of the law” in any federal insurance fraud investigation or other legal proceeding.

Under 18 U.S.C. Section 1033, penalties for insurance company insiders convicted of insurance fraud include statutory fines and up to 10 or 15 years of federal imprisonment depending on the specific allegations involved. Additionally, insurance company insiders will frequently face prosecution under the federal mail fraud, wire fraud, and money laundering statutes as well (among others), and these statutes also carry the potential for huge fines and decades behind bars. Equally, if not more, important, insurance company insiders who are “unsuccessful” in defrauding their employers can still face prosecution for attempt or conspiracy under 18 U.S.C. Section 1033 and 18 U.S.C. Section 1349.

Insurance Fraud: Defense of Insurance Companies

Finally, we also represent insurance companies and their owners and executives in matters involving criminal allegations of insurance company fraud. This includes the fraudulent denial of claims as well as fraud in connection with federal regulatory compliance and law enforcement matters. We defend insurers of all sizes and in all fields, and our attorneys and former federal agents work collaboratively to build comprehensive and custom-tailored defense strategies that are based upon centuries of combined experience on both sides of federal criminal cases.

Our representation of insurance companies includes defending against allegations such as:

  • Fraudulent first-party and third-party claim denials
  • Premium diversion
  • Fee churning
  • Licensing compliance violations
  • Asset diversion in insurance company mergers and acquisitions

Insurance companies accused of engaging in fraudulent practices can face allegations on multiple fronts. We defend insurers in DOJ and FBI investigations as well as audits and investigations involving the Federal Insurance Office (FIO), Federal Emergency Management Agency (FEMA), and other agencies. Oftentimes, these are large-scale investigations involving multiple agencies and tens, if not hundreds, of millions of dollars in potential penalties, and mitigating insurance companies’ exposure requires prompt intervention and highly-strategic representation from a team of skilled attorneys.

About Oberheiden P.C. | Federal Criminal Defense for Individuals and Corporate Entities

Headquartered in Dallas, Texas, Oberheiden P.C. is a federal criminal defense law firm with a national presence. In addition to our in-house defense team, we work with a nationwide network of affiliated counsel and former federal agents who all bring extensive experience to the table. In addition to career federal defense lawyers, our firm includes former senior trial attorneys at the DOJ, former U.S. Attorneys and Assistant U.S. Attorneys, and former agents with the DOJ and FBI (among other agencies). All attorneys, investigators, and trial consultants with Oberheiden P.C. are senior-level advisors, many of whom have 20 to 30 years of experience (or more) handling complex federal matters.

If you are under investigation or facing federal charges for criminal insurance fraud, we can work quickly to intervene in the government’s case and build a strategic defense. We will work quickly, around the clock if necessary, to ensure that you and your company are protected. To learn more in a free and confidential consultation, contact us now.

Schedule a Free and Confidential Insurance Fraud Defense Consultation at Oberheiden P.C.

If you would like to speak with a federal criminal defense lawyer at Oberheiden P.C. about a pending insurance fraud investigation or criminal case, we encourage you to contact us immediately. Call 888-680-1745 to speak with an attorney promptly, or submit your case online and we will be in touch as soon as possible.

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