According to Insurance and Safety Fire Commissioner John F. King, a 32-year-old former AFLAC employee was the ringleader in an insurance fraud scam that netted over $21,000.
Authorities state that the woman encouraged and assisted three other suspects to follow in her footsteps. The three women submitted several fraudulent medical invoices to AFLAC for treatment neither they nor their families ever received, procuring nearly $18,000 across 19 individual claims.
“I am extremely proud of the Special Agents from our Criminal Investigations Division that have worked diligently to take this crime ring down,” said Commissioner King. “Insurance fraud hurts all Georgians by raising annual insurance costs and taking away payments from those who need it,” he added.
Kinds of Insurance Fraud
Basically, people commit fraud when they intentionally misstate current material facts in the hopes of obtaining monetary gain. As the above story illustrates, fraud schemes usually involve multiple persons who may or may not know the whole picture.
Investigators often zero in on major kinds of insurance fraud, which are discussed below. If you filed a form or made a claim that investigators consider suspicious, you could be caught up in a fraud investigation without knowing what’s going on. These investigations often hit people like an unexpectedly big beach wave. The wave knocks them down and disorients them, so they have no idea which way is up.
Never try to “talk your way” out of it. As mentioned, many targets are disoriented and not thinking clearly. Additionally, trained investigators know how to manipulate your words. If investigators show up at your door or invite you downtown for a friendly chat, they intend to arrest you, not exonerate you.
If a Marietta criminal defense lawyer intervenes early, you’ll almost certainly be arrested. But an arrest was probably inevitable anyway. If a lawyer helps you, investigators might not gather enough evidence to prove guilt in court. At that point, the ultimate outcome is all that matters.
Inflated Repair Estimates
Most insurance investigators believe that any repair costs above a pre-set limit are unreasonably high. This approach is evidence-based. Insurance company bean counters look at hundreds or thousands of bills to determine what’s “reasonable.” This approach also has some flaws.
First, you get what you pay for. Not all collision repair centers are created equally. If a cut-rate body shop does a poor job, the owner might need to re-repair the same problem again, and for a higher price. That outcome seems axiomatic, but good luck explaining it to an insurance adjuster.
Second, supply and demand affect price. Generally, body shops cut their prices to attract business during slow periods. If business is brisk, the prices go up.
Owner Give-Ups
A combination of high gas prices, high inflation, job cuts, and high interest rates have caused vehicle repossessions to soar. Desperate people do desperate things. These desperate things include a staged auto theft.
Don’t let these inquiries scare you. Insurance investigators often accuse people of staging car thefts if they’re behind on their payments. That’s enough evidence to draw an insurance company’s attention. But it’s not enough to prove guilt beyond a reasonable doubt. It might not even be enough to get a search warrant.
Occupant Jump-Ins
Occasionally, people literally jump into wrecked vehicles before emergency responders arrive. Then, they claim they have neck and shoulder pain, claims which an unscrupulous doctor is willing to validate. The jump-in scam is more common if the accident was a parking lot fender-bender that didn’t draw an official response. Anyone could claim s/he was in the car at the time of the wreck.
Investigators use very large nets in these cases. People like medical coders, MRI techs, and medical assistants often get charged with insurance fraud, even though they were just doing what their bosses told them to do. That’s not a defense to fraud, but it is an extenuating circumstance that affects punishment. More on that below.
Staged Accident
The swoop-and-squat may be one of the most common insurance fraud scams. It’s at least a two-person operation. One driver “swoops” in front of a victim and slows down to induce a rear-end collision. Another driver “squats” beside the victim to prevent him/her from changing lanes. Back in the 1990s, fraudsters often paid poor nonwhites about $100 each to drive the “swoop” car, the riskiest part of the scam.
Rear-end collisions are always red flags. Investigators almost always ask lots of questions before they pay these claims. A Marietta personal injury lawyer helps victims avoid these questions. Attorneys give these claims legitimacy.
Resolving Insurance Fraud Cases
Under Georgia conspiracy law, every gang member is Mr. Big. The getaway driver and the lookout are every bit as guilty as the guy who robbed the bank. Frequently, investigators target the lookout and convince him to roll over on the robber. They use the same approach in insurance fraud matters. They target the aforementioned clerks and convince them to roll over on their bosses.
Once again, try not to be afraid. The maximum punishment for insurance fraud is high. But there’s an underlying presumption in the law that the punishment should fit the crime.
Some Marietta criminal defense lawyers try to use this presumption as a trial defense, with an argument like “s/he was just following orders.” That argument never holds water. However, an attorney can use this presumption to secure slap-on-the-wrist punishment. Sometimes, it’s impossible to prevent legal consequences in these cases. But it’s possible to minimize these consequences, so that’s the best possible outcome.
Don’t lose your head if investigators accuse you of insurance fraud. For a free consultation with an experienced Marietta criminal defense attorney, contact The Phillips Law Firm, LLC. Virtual, home, and jail visits are available.
