Insurance Fraud Defense in Miami

Dennis Gonzalez Jr. is a former Miami-Dade prosecutor who has been defending people since 2012. Our office answers 24 hours a day.

This page is part of our Economic Crimes Defense practice. For an overview of all fraud charges, see Fraud & Financial Crimes.

What Florida's Insurance Fraud Law Covers

Florida law makes it insurance fraud to act with the intent to injure, defraud, or deceive any insurer by, among other things:

• Presenting or preparing a false claim statement, written or oral, knowing it contains false, incomplete, or misleading information about a material fact.
• Lying on an insurance application, or knowingly hiding material facts on it.
• Billing PIP for a clinic when the person knows the clinic's licensing paperwork was knowingly false.

The law treats a lot of paperwork as a "statement": notices, proofs of loss, invoices, estimates of property damage, bills for services, diagnoses, prescriptions, hospital or doctor records, X-rays, and test results.

It also reaches others in the chain. Doctors, chiropractors, other licensed practitioners, and attorneys who knowingly and willfully help, conspire with, or urge someone to commit insurance fraud can be charged too. So can hospital operators and staff who knowingly and willfully let the hospital be used in a fraud scheme.

Staged Accidents, Solicitation, and PIP Cases

Some auto insurance conduct is charged on its own terms, no matter the dollar amount:

• Staged crashes. Organizing, planning, or knowingly taking part in an intentional car crash, or a scheme to create paperwork for a crash that never happened, to make injury or PIP claims is a second-degree felony with a minimum of 2 years in prison.
• Soliciting accident victims to defraud. Soliciting business from a person involved in a car accident, with intent to defraud, to make or settle injury or PIP claims is a second-degree felony with a minimum of 2 years in prison.
• Soliciting within 60 days. Soliciting crash victims within 60 days of the accident by any means other than advertising directed to the public, to make injury or PIP claims, is a third-degree felony.
• Health care providers and PIP. A licensed health care practitioner found guilty of insurance fraud for an act relating to a PIP policy loses the license to practice for 5 years and cannot be reimbursed for PIP benefits for 10 years.

Other Conduct the Statute Names

• Waiving deductibles as a business practice. A provider, other than a hospital, who regularly bills a "usual and customary" charge while agreeing or intending not to collect the deductible or copayment can be charged with insurance fraud. The law does not apply when providers waive or reduce amounts as part of a bodily injury settlement or verdict.
• Contractors and property claims. A contractor who knowingly or willfully, with intent to injure, defraud, or deceive, pays, waives, or rebates a property insurance deductible commits a third-degree felony.

Penalties

For most insurance fraud charges, the degree depends on the value of the property involved:

• Less than $20,000: third-degree felony (up to 5 years in prison and a fine of up to $5,000).
• $20,000 to under $100,000: second-degree felony (up to 15 years and a fine of up to $10,000).
• $100,000 or more: first-degree felony (up to 30 years and a fine of up to $10,000).

Civil penalties on top. A person convicted of insurance fraud to get auto insurance money also faces a civil penalty: up to $5,000 for a first offense, more than $5,000 up to $10,000 for a second, and more than $10,000 up to $15,000 for a third or later. For a staged crash, the civil penalty is at least $15,000 and up to $50,000.

Restitution and the dollar figure. The value the State can actually prove drives the degree of the charge. Testing that number is often one of the most important parts of the defense.

Who Investigates: DFS Fraud Investigators

Florida's Department of Financial Services and its Division of Criminal Investigations investigate suspected insurance fraud. Under Florida law:

• They can administer oaths, ask witnesses to appear, and collect evidence.
• They cannot force you to give testimony or documents in their investigation without first going to circuit court and getting an order.
• Division investigators are state law enforcement officers. They can make arrests, execute arrest warrants and search warrants, and serve subpoenas.

Insurance companies also have their own investigators, and the law protects many reports of suspected fraud that are made to the division and the National Insurance Crime Bureau.

If an Investigator or Adjuster Asks for a Statement

1. Be polite. Get the name, agency or company, and phone number.
2. Do not give a recorded statement about suspected fraud without talking to a defense lawyer first.
3. Do not "fix" or add to paperwork after the fact. Do not delete texts, photos, or records.
4. Do not contact the other drivers, passengers, clinic, or tow company to compare stories.
5. Understand who you are talking to. A state investigator is a law enforcement officer. What you say can be used in a criminal case.
6. Call us right away. (305) 209-0384.

If you think charges are coming, we can find out whether there is a warrant and, in many cases, arrange a self-surrender with bond planned ahead. See also Bond & Nebbia Hearings.

Why Early Counsel Matters

• We speak with the investigator for you and find out what they are looking at.
• We preserve the records that show a real accident, real treatment, or an honest mistake.
• We test intent. Insurance fraud requires intent to injure, defraud, or deceive. A wrong number on a form is not always a crime.
• We test the value. The amount the State can prove sets the degree of the charge.
• We think about your license if you are a health care provider, contractor, or other licensed professional.

Why Choose Dennis Gonzalez Law, P.A.

• Former Miami-Dade prosecutor.
• Defending people since 2012.
• Super Lawyers recognition and an Avvo Rating of 10.0.
• Bilingual office — se habla español.
• We answer 24 hours a day. Call (305) 209-0384.

You can read about some of our past cases on our Results page.

Frequently Asked Questions

I was only a passenger in the accident. Can I be charged?

Possibly. The staged-crash law covers anyone who organizes, plans, or knowingly participates. What you knew is the key question.

The DFS investigator says I have to come in and talk. Do I?

Under Florida law, the department or division cannot compel your attendance in its investigation unless a circuit court orders it. A subpoena or court order is different: never ignore one. Talk to a lawyer before you respond.

Is it fraud if my claim had a mistake in it?

Not by itself. The law requires intent to injure, defraud, or deceive, and for false statements, knowledge that the information was false, incomplete, or misleading.

Can I lose my professional license?

Yes. A licensed health care practitioner found guilty of PIP-related insurance fraud loses the license for 5 years, and other licensing consequences are possible.

How fast can you help?

Our office answers 24 hours a day. Call (305) 209-0384.