Understanding Examples of Federal Insurance Fraud

Updated June 2025

A large part of the U.S. GDP relies on the health of major insurance companies. Therefore, insurance fraud is a significant white-collar federal crime in New Jersey. Knowing the elements of federal insurance fraud can help individuals and businesses avoid illegal practices and common insurance scams.

Confidentially discuss potential insurance fraud with criminal defense lawyer Peter Katz today.

Overview of Federal Insurance Fraud Legislation

Insurance fraud is primarily criminalized by 18 U.S.C. § 1033. Insurance fraud involves claims that an individual or business entity deceived an insurance company or agent to obtain coverage, payouts, or better premiums. Employees or agents of insurers can also be held accountable for misappropriation and related white-collar crimes under this statute. Although charges under 18 U.S.C. § 1033 require U.S. attorneys to prove that the fraud impacted ‘interstate commerce,’ nearly all insurance fraud claims involve multi-state companies.

Types of Insurance Fraud

Knowledge is essential to federal insurance fraud, meaning you must knowingly deceive the insurance company through false statements or documents. Negligence can give rise to civil liability for the return of insurance funds, but it does not generally support criminal charges. Below are some types of actionable federal insurance fraud in New Jersey.

Health Care Insurance Fraud

Medical insurance fraud often occurs when businesses, medical professionals, or individuals submit false information to health insurers to obtain unauthorized payments and benefits. Common examples include doctors billing for services not provided, overstating the nature of the services offered, or including incorrect diagnosis codes to obtain payment.

Auto Insurance Fraud

Common examples of car insurance fraud include staging or lying about an accident to obtain benefits or falsely claiming a vehicle was stolen. Alleging hit-and-run accidents that did not occur or intentionally destroying a car to get insurance money are also examples of auto insurance fraud.

Life Insurance Fraud

Most life insurance fraud cases involve lying about your overall health and eligibility on application forms to obtain coverage or lower premiums, for example, failing to disclose dangerous hobbies or health conditions. Rarely have these cases also involved faking a death to receive benefits.

Consequences of Federal Insurance Fraud Convictions

The penalties for federal insurance fraud under 18 U.S.C. § 1033 can include the following:

• Up to 10 years in prison
• Fines
• Restitution
• Asset forfeiture
• Civil liability
• Higher premiums
• Inability to obtain future insurance coverage and benefits

If you’re being investigated for insurance fraud in New Jersey, contact an experienced federal criminal defense attorney immediately.

Dedicated Federal Insurance Fraud Defense Lawyer

If you’re unsure whether specific actions qualify as insurance fraud, speak with reputable New Jersey white-collar crimes defense attorney Peter Katz. He has over 30 years of legal experience as a federal prosecutor and can confidentially help you understand and defend against insurance fraud charges. Schedule a legal consultation with him today by calling (609) 849-3179 or connecting with his federal defense team online.