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NEW YORK INSURANCE FRAUD

New York Criminal Lawyers Tilem & Associates have been seeing an increase in the enforcement of economic crimes generally and insurance fraud cases more specifically, especially as those cases pertain to Disability Fraud and Workers Compensation Fraud (collectively known as health care fraud). Currently, the firm is involved in a jury trial, defending a person accused of Workers Compensation Fraud. As violent crime has fallen, prosecutors and law enforcement officers have definitely turned their attention to fraud cases but these types of cases can be difficult to prove and filled with pitfalls.

In addition, enforcement by the government can take many forms including the above mentioned criminal prosecution but enforcement can also take the form of civil or administrative proceedings to terminate benefits, seek repayment of benefits paid out (restitution) or impose civil statutory penalties. These types of proceedings each have nuances and complications and a person who finds themselves the target of any investigation or enforcement action should seek an attorney experienced with disability or workers compensation fraud cases and not just go back to their prior attorney who helped them obtain the benefits.

In the criminal trial currently pending in Bronx Supreme Court, our client is accused of fraud for obtaining workers compensation benefits based upon Post Traumatic Stress Disorder (PTSD). While the client was collecting benefits and stating that s/he was a prisoner in her own home and unable to leave her home, the government alleges that she went on cruises and was earning income doing odd jobs for others. Highlighting the complexity of these cases, attempts to cut off the client’s workers compensation benefits before her arrest were unsuccessful and the client still collects benefits to this date despite her arrest almost two years ago.

In another case involving disability fraud, the firm represents a woman accused of fraudulently obtaining federal disability benefits. While the government has decided not pursue criminal charges they are pursuing federal statutory penalties against the client for alleged false statement in the application and the failure to correct those false statements. These civil penalties can be substantial, $5000 per omission or false statement per month. However, it is possible to settle these claims without an admission of wrongdoing and (believe It or not) pay all or some of the civil penalty out of continuing disability benefits. Also, believe it or not, the fact that you agreed to pay a civil penalty cannot be used as evidence to attempt to cut off your benefits.

These types of cases can be very complicated and they can also have very serious consequences such as prison, fines, probation, restitution, loss of benefits and substantial financial penalties. If you believe that you may be under investigation for any type of insurance, workers compensation, disability, health care or welfare fraud, please contact us for a free consultation.