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Ohio Insurance Fraud Laws

Types of Insurance Fraud

In Ohio, insurance fraud can occur in numerous different ways from health insurance, to property and casualty insurance, to life and disability insurance. Insurance fraud activities can be either internal or external.

What Is The Difference Between External And Internal Insurance Fraud?

External fraud includes activities committed by insurance applicants, policyholders, third-party claimants or those who provide services to claimants.

Internal fraud occurs within the insurance industry itself and includes misrepresentation of facts by industry employees for personal gain or to prevent regulators from taking certain actions.

How Does A Person Commit Insurance Fraud?

Insurance fraud includes inflating claims, misrepresenting facts in order to obtain insurance coverage or lower premiums, a doctor padding a health insurance claim, an individual submitting false claims, or claims being made after false burglary reports. Insurance companies are required to report suspected fraudulent insurance claims to the Ohio Department of Insurance.

Who Enforces and Prosecutes Insurance Fraud Laws?

Ohio state and local prosecutors handle insurance fraud cases under the state's penal code. Ohio state laws and federal laws also permit law enforcement to pursue cases federally. In those instances, the crime of "insurance fraud" is usually pursued as "mail fraud," "criminal racketeering," or other federal offenses.

The following table highlights the main provisions of Ohio's insurance fraud laws.
See also Association of Certified Fraud Examiners, Fraud, Fraud and Financial Crimes, and Arson.

Code Section

Ohio Revised Code §2913.47

What is Prohibited Knowingly lying about, or concealing an important fact in connection with a insurance claim or payment made under an insurance policy. Applies to issuing fake insurance policies and rate-fixing. Also includes conspiring to do any of the above.
  • First Degree Misdemeanor if fraud is less than $1000
  • Fifth Degree Felony if fraud is between $1000-$7500
  • Fourth Degree Felony if fraud is between $7500-$150,000
  • Third Degree Felony if fraud is $150,000 or more.
  • Possible civil penalties including fines, revocation of business license, etch.
Who Can Be Prosecuted Consumers, providers (such a doctor and auto repair shop), insurance Companies, adjusters, and others
Types of Insurance Fraud Automobile repair and accidents, medical/health care, life, workers' compensation, fire, property (repairs and property claims adjustments)

Enforcement Agencies

If you feel you have been victimized by insurance fraud, here is some contact information that can help you:

Should I Hire A Criminal Defense Attorney?

Ultimately that is your decision to make. However, insurance fraud laws can sometimes get complicated. It may it wise to consult an experienced Ohio criminal defense attorney if you have questions about your specific situation.

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