court is almost always an option for recourse, but while something may leave you vulnerable to a lawsuit, it may not be criminally illegal. If you have been notified of allegations of insurance fraud, it may be beneficial to retain a Phoenix fraud defense lawyer with Suzuki Law Offices so they can intervene as soon as possible.
When you work with our firm, you benefit from an attorney who is experienced in all manner of fraud and other white-collar crimes. Many times, insurance fraud cases can be charged in criminal courts at state and federal levels as well as civil courts. You need an attorney who is versed in the nuance of these cases and comfortable in a trial setting in state and federal courts, and that is what we can provide.
Understanding Insurance Fraud in Arizona
Insurance fraud is illegal both federally and in Arizona. In fact, there are several laws in place regarding insurance and healthcare fraud. Arizona Statute 20-463 states that fraud occurs when you falsely represent information to the insurance company. This can include behaviors such as:
- Double billing
- Fraudulently billing
- Overbilling
- Falsifying client information
In addition to state codes, Arizona has developed the Arizona Healthcare Cost Containment System (AHCCCS), which is meant to oversee many government-funded programs, including Medicaid and Medicare. Under the Arizona Healthcare Cost Containment System (AHCCCS), the guidelines of what is considered fraud are similar to those of federal regulations. You may be unsure of what to do if you were indicted on fraud charges, but consulting your attorney will always be the best route for questions.
Investigating Criminal Charges in Arizona Insurance Fraud
Insurance fraud in Arizona may fall under state and federal jurisdiction, depending on the details of the case. The Office of the Inspector General is the leading agency in Arizona regarding Medicaid and Medicare fraud, and they tend to work closely with other state and federal agencies such as:
- Medical fraud control unit
- Federal Bureau of Investigation
- Drug Enforcement Agency
- Health and Human Services
In many cases of insurance fraud, there may be additional questions surrounding prescriptions, money laundering, or kickbacks, which can require a more active role from other agencies. If you are ever wondering when to contact a Phoenix criminal defense lawyer, the answer is as soon as you are notified of concerns or allegations. Cooperating with law enforcement and investigations without consulting an attorney may only open you up to more charges and trouble.
Consequences of Arizona Insurance Fraud
In the state of Arizona, insurance fraud can be considered a Class 6 felony, which can be compared with a Class 1 misdemeanor. This classification allows leeway that may be offered if the judge determines that a felony is too harsh a punishment for a particular case. This is pursuant to Arizona Code 13-604.
First-Degree Felony
This could result in a prison sentence of 25 years and is categorized as a class B felony. First-degree felony insurance fraud is reserved for those who commit over 1 million dollars in fraud. The judge may determine that additional fines are appropriate.
Second-Degree Felony
A second-degree felony insurance fraud conviction can result in fines and prison time not exceeding 25 years. This would be appropriate for fraud committed in the amount of $50,000 to $1,000,000.00. A second-degree felony insurance fraud conviction would be a class C felony.
Third-Degree Felony
A third-degree felony insurance fraud conviction occurs when you are convicted of fraud valued at $3,000 to $50,000. This would be considered a class D felony. Sentencing can result in fines and incarceration for up to seven years.
Fourth-Degree Felony
This would occur when the defendant is responsible for $1,000-$3,000 in fraud. Sentencing may include confinement of up to five years and fines. This is considered a Class E felony.
Fifth-Degree Fraud
This is the lowest charge for insurance fraud for amounts lower than $1,000. This is considered a class A offense and would typically result in up to one year in prison. In some cases, this can be reduced with no jail time and probation.
Professional Implications of Criminal Charges
As a care provider, whether in a medical or behavioral health setting, any criminal charges you face may affect your licensure status. In many cases, a report will be made to your licensing board as soon as concerns arise. Your employer will also be informed of concerns if the fraud is suspected to have happened through the agency or practice affiliation with the insurance provider.
In some cases, you may face immediate suspension or restriction of your license while the investigation is underway. Your licensing body will likely investigate the complaint itself and use the investigation of law enforcement agencies to further inform its decision. A final decision can be made after the investigation, which may include revocation.
Additionally, following the accusation and conviction of insurance fraud, you may find yourself on an exempt list of providers who are unable to provide care that bills Medicaid, Medicare, or private insurance included in the initial complaint. This may be lifelong and can dramatically affect future employment opportunities. Your best chance at recovering your ability to work in your field is to contact our healthcare fraud attorney with Suzuki Law as soon as you are aware there may be a problem.
Managing Criminal Charges for Arizona Insurance Fraud
Allegations of insurance fraud are a big deal and should not be taken lightly, even if you have nothing to hide. Cooperating with investigators without consulting an attorney will only increase your chances of the prosecution filing additional charges. Take steps immediately to ensure you have a competent defense, and contact Suzuki Law Offices today.
When you contact us for an initial consultation, we can discuss the details of your case to determine its strengths and weaknesses. We may also be able to assist you in setting expectations for a realistic outcome for your situation. All initial consults are free, so don’t delay in securing someone to protect your rights.
Call or text (602) 682-5270 or complete a Free Case Evaluation form