{"id":374497,"date":"2016-03-31T21:35:48","date_gmt":"2016-04-01T02:35:48","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/state\/missouri-law\/missouri-insurance-fraud-laws.html"},"modified":"2016-06-19T23:00:00","modified_gmt":"2016-06-20T04:00:00","slug":"missouri-insurance-fraud-laws","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/state\/missouri-law\/missouri-insurance-fraud-laws.html","title":{"rendered":"Missouri Insurance Fraud Laws"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n    \n    <div class=\"fl-page-articles fl-section-main fl-section-main-full-width\">\n        <h1 class=\"fl-no-margin-top\">Missouri Insurance Fraud Laws<\/h1>\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    <p><i>Created by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw&#8217;s team<\/a> of legal writers and editors<\/i><\/p>\n\n                | Last updated\n        <time>\n                            June 19, 2016\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n<p>In Missouri, <a href=\"https:\/\/www.findlaw.com\/criminal\/criminal-charges\/insurance-fraud.html\" target=\"_blank\">insurance fraud<\/a> can occur in many different ways. An insurance fraud offense typically occurs when someone tries to make money from an insurance transaction through lies or deception. Insurance providers can also violate insurance laws in many ways, including misrepresentation in sales and inappropriate cancellation or denial of coverage. Examples of insurance fraud include:<\/p>\r\n<ul>\r\n<li><u>Workers&#8217; Compensation<\/u>: An employee claims to have suffered an injury while on the job and either didn\u2019t suffer an injury at all, or was injured while doing something not work related. Employers can also commit workers&#8217; compensation fraud by understating their number of employees or the type of work they do.<\/li>\r\n<li><u>Property Fraud<\/u>: Someone exaggerates the amount of damage incurred to their home, car, or other possession; deliberately damages their possessions for reimbursement by the insurance company; or seeks reimbursement for a lost or stolen item that was neither lost nor stolen.<\/li>\r\n<li><u>Casualty Fraud<\/u>: Someone fakes or exaggerates an accident or injury to receive money from an insurance company.<\/li>\r\n<\/ul>\r\n<h2>Who Enforces and Prosecutes Insurance Fraud Laws?<\/h2>\r\n<p>Missouri state and local prosecutors handle insurance fraud cases under the criminal and insurance codes. When insurance companies or agents act illegally or unprofessionally, the matters can also be handled administratively by the Missouri <a href=\"http:\/\/difp.mo.gov\/\" target=\"_blank\" rel=\"noopener\">Department of Insurance, Financial Institutions, &amp; Professional Registration<\/a> (DIFP), for example by revoking a license or imposing a fine. The federal government can also prosecute insurance fraud under a number of federal criminal laws, such as mail fraud or <a href=\"https:\/\/www.findlaw.com\/criminal\/criminal-charges\/racketeering-rico.html\" target=\"_blank\">racketeering<\/a>.<\/p>\r\n<h2>How Do I File a Complaint Against an Insurance Company?<\/h2>\r\n<p>The following table highlights the main provisions of Missouri&#8217;s insurance fraud laws.<\/p>\r\n<table cellspacing=\"0\" cellpadding=\"0\" border=\"1\">\r\n<tbody><tr><td><p><b>Code Sections<\/b><\/p>\r\n<\/td>\r\n<td><p>Missouri Revised Statutes (MRS) Title 24 &#8211; <a href=\"http:\/\/www.moga.mo.gov\/statutes\/statutes.htm#T24\" target=\"_blank\" rel=\"noopener\">Business and Financial Institutions<\/a><\/p>\r\n<p>MRS Sections <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C500-599\/5690000100.HTM\" target=\"_blank\" rel=\"noopener\">569.100<\/a> and <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C500-599\/5690000120.HTM\" target=\"_blank\" rel=\"noopener\">569.120<\/a> &#8211; Property Damage<\/p>\r\n<ul>\r\n<li>Property damage in the first degree prohibits causing property damage over $100,000 to defraud an insurer<\/li>\r\n<li>Property damage in the second degree prohibits damaging property to defraud an insurer<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr><tr><td><p><b>What is Prohibited?<\/b><\/p>\r\n<\/td>\r\n<td><p><u>For consumers<\/u>: Knowingly lying about or concealing an important fact in connection with an insurance claim or payment made under an insurance policy or damaging property to reap insurance benefits.<\/p>\r\n<p><u>For insurance providers<\/u>: Issuing fake insurance policies, rate-fixing, <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C300-399\/3750000144.HTM\" target=\"_blank\" rel=\"noopener\">misrepresenting insurance<\/a> when selling it, denying compensation for covered incidents, operating an insurance company in bad faith, etc.<\/p>\r\n<\/td>\r\n<\/tr><tr><td><p><b>Penalties<\/b><\/p>\r\n<\/td>\r\n<td><p>Possible criminal penalties include jail time, fines, and <a href=\"https:\/\/dictionary.findlaw.com\/definition\/restitution.html\" target=\"_blank\" rel=\"noopener\">restitution<\/a>. Possible civil penalties including fines, <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C300-399\/3750000002.HTM\" target=\"_blank\" rel=\"noopener\">cancellation<\/a> of your insurance policy, and <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C300-399\/3750000141.HTM\" target=\"_blank\" rel=\"noopener\">revocation<\/a> of insurance or professional license.<\/p>\r\n<p>For example, the crime of property damage to defraud an insurer of over $100,000 is a Class D felony subject to <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C500-599\/5580000011.HTM\" target=\"_blank\" rel=\"noopener\">prison for up to 4 years<\/a> and a <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C500-599\/5600000011.HTM\" target=\"_blank\" rel=\"noopener\">fine of up to $5,000<\/a> On the other hand, property damage to defraud an insurer of less than $100,000 in damage is a Class B misdemeanor punishable by up to 6 months in jail and a <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C500-599\/5600000016.HTM\" target=\"_blank\" rel=\"noopener\">maximum $500 fine<\/a>.<\/p>\r\n<p>For insurance providers, violations can be criminal with various misdemeanor or felony repercussions. Civil insurance provider violations are <a href=\"http:\/\/www.moga.mo.gov\/statutes\/C300-399\/3740000049.HTM\" target=\"_blank\" rel=\"noopener\">classified from Level 1 to 5<\/a> (with 5 being the most severe) based on the seriousness of the bad conduct. In an administrative proceeding, a person or company can be required to pay for each violation up to $1,000 for Level 2, $5,000 for Level 3, $10,000 for Level 4, and $50,000 for Level 5 violations or $250,000 per year for multiple violations. If imposed by a court proceeding, penalties can increase to up to $20,000 for Level 4 and $1,000,000 for Level 5 violations with no limit for multiple violations. These civil fines and forfeitures are distributed to the Missouri public schools.<\/p>\r\n<\/td>\r\n<\/tr><tr><td><p><b>Who Can Be Prosecuted?<\/b><\/p>\r\n<\/td>\r\n<td><p>Consumers, providers (such a doctor or auto repair shop), insurance companies, adjusters, and others.<\/p>\r\n<\/td>\r\n<\/tr><tr><td><p><b>Types of Insurance Fraud &amp; Examples<\/b><\/p>\r\n<\/td>\r\n<td><ul>\r\n<li><a href=\"https:\/\/www.findlaw.com\/injury\/car-accidents\/automobile-insurance-policy-coverage.html\" target=\"_blank\">Automobile Insurance<\/a> and <a href=\"https:\/\/www.findlaw.com\/injury\/car-accidents\/car-accident-basics.html\" target=\"_blank\">Accidents<\/a> &#8211; stolen car scams, staged car accidents, accepting checks for small accidents without fixing the vehicle<\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/employment\/wages-and-benefits\/health-insurance-benefits.html\" target=\"_blank\">Health Insurance<\/a>, <a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare-an-overview.html\" target=\"_blank\">Medicare<\/a>, or <a href=\"http:\/\/www.medicaid.gov\/\" target=\"_blank\" rel=\"noopener\">Medicaid<\/a> Claims &#8211; providing unnecessary medical procedures or billing for services or supplies never provided<\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/smallbusiness\/liability-and-insurance\/small-business-insurance-plans.html\" target=\"_blank\">Small Business Insurance<\/a> &#8211; arson to profit from a failing business (usually from the property insurance policy)<\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/realestate\/owning-a-home\/insuring-your-home.html\" target=\"_blank\">Home<\/a> or <a href=\"https:\/\/www.findlaw.com\/realestate\/landlord-tenant-law\/renter-s-insurance.html\" target=\"_blank\">Renter&#8217;s Insurance<\/a> &#8211; false or misleading property loss claims, such as overstating the value of items that were stolen<\/li>\r\n<li><u>Insurance Applications<\/u> &#8211; lying about medical history to qualify or pay less for life insurance<\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/what-is-disability-insurance.html\" target=\"_blank\">Disability Insurance Benefits<\/a> &#8211; misrepresenting an injury to receive disability benefits<\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/employment\/losing-a-job\/unemployment-insurance-overview.html\" target=\"_blank\">Unemployment Insurance<\/a> &#8211; falsely obtaining benefits when you\u2019re working<\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-basics.html\" target=\"_blank\">Workers&#8217; Compensation<\/a> &#8211; claiming to be injured when not or claiming an injury on vacation happened at work<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr><tr><td><p><b>Insurance Fraud Enforcement Agencies<\/b><\/p>\r\n<\/td>\r\n<td><p>The agency to report insurance fraud you\u2019ve experienced or witnessed depends on the type of insurance. If you feel you\u2019ve been victimized by insurance fraud, contact the Missouri <a href=\"http:\/\/insurance.mo.gov\/consumers\/complaints\/\" target=\"_blank\" rel=\"noopener\">Insurance Consumer Hotline<\/a> at 1-800-726-7390.<\/p>\r\n<p>You can call your Medicare plan provider to ask them about possible fraud. If you\u2019re uncomfortable doing so or the issue remains unresolved, you can reach the <a href=\"https:\/\/www.smpresource.org\/Default.aspx\" target=\"_blank\" rel=\"noopener\">Senior Medicare Patrol<\/a> (SMP) Program at 1-888-515-6565.<\/p>\r\n<p>Medicaid or other Public Assistance fraud can be reported <a href=\"http:\/\/dss.mo.gov\/dls\/public-assistance-fraud-form.htm\" target=\"_blank\" rel=\"noopener\">online<\/a> or you can call the Missouri regional office closest to you:<\/p>\r\n<ul>\r\n<li>Central: 877-770-8055<\/li>\r\n<li>Eastern: 877-860-3052<\/li>\r\n<li>Southeast: 877-603-4323<\/li>\r\n<li>Western: 877-698-0760<\/li>\r\n<li>Southwest: 877-839-4316<\/li>\r\n<\/ul>\r\n<p>If you suspect a licensed professional, such as your doctor, chiropractor, or counselor, has committed insurance fraud, you may also want to make a complaint with their professional licensing board. Contact information for the boards is available on the <a href=\"http:\/\/pr.mo.gov\/contact-us.asp\" target=\"_blank\" rel=\"noopener\">Missouri Division of Professional Registration<\/a> website.<\/p>\r\n<p>To report Worker&#8217;s Compensation fraud in Missouri call 1-800-592-6003.<\/p>\r\n<\/td>\r\n<\/tr><\/tbody><\/table>\r\n<p>Because insurance fraud laws can sometimes be complicated, it\u2019s a good idea to consult an experienced <a href=\"https:\/\/lawyers.findlaw.com\/criminal-law\/missouri\/\" target=\"_blank\" rel=\"noopener\">criminal defense attorney<\/a> if you have questions about your specific situation.<\/p>\r\n<h2>Related Resources<\/h2>\r\n<ul>\r\n<li><a href=\"https:\/\/www.findlaw.com\/criminal\/criminal-charges\/fraud.html\" target=\"_blank\">Fraud<\/a><\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/criminal\/criminal-charges\/fraud-financial-crimes.html\" target=\"_blank\">Fraud and Financial Crimes<\/a><\/li>\r\n<li><a href=\"https:\/\/www.findlaw.com\/criminal\/criminal-charges\/arson.html\" target=\"_blank\">Arson<\/a><\/li>\r\n<li><a href=\"http:\/\/www.acfe.com\/\" target=\"_blank\" rel=\"noopener\">Association of Certified Fraud Examiners<\/a><\/li>\r\n<\/ul>\r\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" 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