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Anti-Fraud Case Files

Our Corporate & Financial Investigations Department identifies, investigates, and seeks prosecution on internal and external fraud. We partner with state and federal law enforcement, regulatory agencies, and other insurance companies in the fight against these crimes.

Health care fraud is a violation of state and/or federal law. Under federal law it is a felony offense (18 USC 1347), punishable by a fine of up to $250,000, and/or up to 10 years’ imprisonment. If the violation results in serious bodily injury, up to a 20-year prison term is possible.

Sample cases of successful fraud prosecution

• Case #1 — Claims analysis results in guilty plea of psychotherapy business owner
• Case #2 — Chiropractor pleads guilty to insurance fraud and theft by deception
• Additional fraud and abuse convictions