Is Insurance Fraud a Felony in PA?

by | Sep 20, 2022

Insurance fraud could be a felony in PA if prosecutors can prove specific facts. The law lists specific criminal acts over which the Commonwealth of Pennsylvania has the authority to charge as third-degree felonies.

Otherwise, acts of insurance fraud are first-degree misdemeanors. Both classifications carry the potential of facing prison time and thousands in fines if convicted. Get legal advice about defending against a conviction from an experienced criminal defense attorney as soon as possible if you or a family member were arrested.

In This Article

Our Philadelphia insurance fraud defense lawyers help you understand how the law defines ‘felonies,’ what the law considers insurance fraud, penalties associated with a conviction, and other relevant details. Shuttleworth Law wrote this post for individuals facing PA insurance fraud charges (or their worried loved ones) and who want general legal information after an arrest or investigation.

Overview: How Pennsylvania Law Defines ‘Felony’

Felonies are serious criminal charges in Pennsylvania. Numerous crimes fall under this type of classification, such as manslaughter, insurance fraud, and patronizing prostitutes. PA also recognizes three grades of felonies, including capital, first-, second-, and third-degree.

In general, the hallmarks of felony crimes in PA include the following:

  • Prison sentences for up to more than five years (18 Pa.C.S. § 1103)
  • Fines of $15,000 or more (18 Pa.C.S. § 1101)
  • Enhanced penalties for subsequent offenses
  • Greater ‘collateral’ consequences after prison
  • Victim restitution
  • Civil action consequences

If convicted of felony insurance fraud, your life and its future could dramatically change course. However, you still have time to aggressively defend your charges before the final verdict. Apply the law to the unique facts of your case with a criminal defense attorney when mounting a legal strategy against the prosecutor’s allegations.

Related Article: What is a Felony in Pennsylvania?

Defining Felony Insurance Fraud

Insurance fraud is a felony in PA when a violation under 18 Pa.C.S. § 4117 (a)(1) through (a)(8) occurs. The law grades these violations as third-degree felonies.

In simple, basic terms, Commonwealth prosecutors are alleging that you “knowingly and with the intent to defraud” committed felony insurance fraud with “false, incomplete, or misleading information” when you were:

  1. Filing documentation with public agencies
  2. Issuing statements to insurance companies
  3. Conspiring to issue statements with others
  4. Using another person’s insurance cards
  5. Making legal or financial gains from violations with others
  6. Acting as an unlicensed agent, broker, or insurer
  7. Permitting others to use a medical facility for fraudulent reasons
  8. Hiring someone to influence independent, insurance-related legal issues

The acts of felony-level insurance fraud listed above are abridged for a general audience. Legal definitions of each act are much more detailed, which means that prosecutors have their work “cut out” for them if they decide to charge you with this type of crime since they hold the burden of proof. Even a single misstep on their part could result in a favorable outcome for your case.

About Misdemeanor Insurance Fraud

The same statute also recognizes lower-level insurance fraud crimes. Under subsection (b), you could face a first-degree misdemeanor.

Acts of misdemeanor insurance fraud charges include legal or medical professionals employing someone to recommend services with respect to an insurance benefit, claim, or contact information provided. This subsection also makes it illegal to file applications containing false or misleading information.

Related Article: What Is a Misdemeanor in Pennsylvania?

What Is the Punishment for Felony Insurance Fraud in PA?

The punishment for felony insurance fraud in PA includes up to seven years imprisonment and $15,000 in fines. A person only faces insurance fraud penalties after a conviction and a court order. Pennsylvania’s criminal insurance fraud law also specifically allows for victim restitution and civil proceedings.

Related Article: Are Plea Deals Worth It in Pennsylvania?

Common Insurance Fraud Defenses

A third-degree felony insurance fraud conviction has the potential to turn your life upside down. However, it is important to remember that you are innocent until proven guilty by prosecutors. Your insurance fraud charges are defensible, and when planned and executed well, the right strategy could result in getting your charges dropped, dismissed, reduced, or beaten at a criminal trial.

Examples of common insurance fraud defenses include:

  • It was impossible for you to commit insurance fraud
  • You did not act knowingly or intentionally
  • Prosecutors made a mistake of fact
  • You faced civil rights violations during or after arrest or during a search
  • Or a combination of defenses specific to your case

A solid criminal defense is powerful, but you must protect your case early on in the process. By facing the courtroom unrepresented, prosecutors will have a clear advantage based on evidence and knowledge of the law. Fight fire with fire by hiring insurance fraud defense lawyers in Pennsylvania to investigate your charges, preserve evidence, present in court, and pursue opportunities toward meeting your objectives.

Related Article: How Strong Is an Alibi Defense?

It is challenging to select a reasonable, effective defensive strategy against insurance fraud charges without facts and limited knowledge of a very complex situation. Deploying the right tactics requires more than just interpreting laws; the process may also require you to procure experts, deal with prosecutors, and preserve vital evidence.

As such, hiring an insurance fraud defense attorney ensures that you have the information you need to present a compelling defense. Otherwise, your entire future could be on the line by going unrepresented.

Shuttleworth Law Offers Free Case Evaluations

The Philadelphia insurance fraud defense lawyers at Shuttleworth Law want to help you bring as much control back to your side of the courtroom as possible. Find out what our legal team thinks about your charges at no cost or obligation. Call (215) 774-1371 for your Free Case Evaluation or message us privately via our online contact form.

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