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Insurance Fraud in Ohio Overview

Updated: August 19, 2021
Nicholas Gounaris
By Nicholas Gounaris

Nicholas G. Gounaris is a skilled trial lawyer and founding partner of Gounaris Abboud law firm. He provides clients of the firm with competent legal representation and focuses his law practice in the areas of DUI Defense, Criminal Defense, Family Law Issues, Federal Criminal Law and Personal Injury cases.

insurance fraud ohio

Ohio Criminal Defense Lawyers Discuss Ohio Insurance Fraud

Insurance companies have a responsibility to investigate fraud. Fraudulent insurance claims direct money and resources away from people who filed legitimate claims, which hurts everybody.

However, the greatest injustice occurs when an insurance company falsely accuses you of committing insurance fraud for filing a legitimate claim. 

Even though the insurance companies have experienced investigators who attempt to detect fraud, they do not always get it right. Law enforcement investigators assigned to investigate fraud are not always right either.

Therefore, you need a strong Ohio criminal defense lawyer by your side if you have been charged with insurance fraud or are under investigation for insurance fraud in Ohio. 

What Is Ohio Insurance Fraud?

Insurance fraud is an attempt to get money for nothing. Most commonly, insurance fraud occurs when a person intentionally files either a false claim or an exaggerated claim. Examples of false insurance claims, referred to as “hard fraud,” in Ohio are:

  • Staging a car accident and claiming injuries; 
  • Causing an accident and claiming that someone else is responsible;
  • Lying on an insurance application;
  • Billing Medicare/Medicaid for medical procedures that were not performed;
  • Burning down a house to collect the insurance proceeds; or 
  • Claiming workers’ compensation benefits for a work injury even though you were hurt while not working or not hurt at all.

An example of an exaggerated claim or “soft fraud” includes treating with a medical provider even after reaching a medical result to increase the claim’s value.

Penalties for Insurance Fraud in Ohio

Under Ohio law, you are guilty of insurance fraud if, with the intent to make a false or deceptive claim, you purposely do one of the following or aid another to do so:

  • Acquire a benefit under an insurance policy; 
  • File a claim under an insurance policy; or 
  • Obtain an insurance policy.

The possible penalties you face for a conviction of Ohio insurance fraud depend on the amount of money involved. Fraud involving any amount under $1,000 is a first-degree misdemeanor. A first-degree misdemeanor in Ohio carries a maximum penalty of one year in jail. 

Insurance fraud in Ohio becomes a felony when the amount involved exceeds $1,000. Ohio’s insurance fraud law breaks down the felony offenses as:

  • A fifth-degree felony for an amount between $1,000 and $7,500, with a maximum penalty of one year in prison;
  • A fourth-degree felony for an amount between $7,500 and $150,000, with a maximum of 18 months in prison; and
  • A third-degree felony for any amount exceeding $150,000, carrying a maximum prison sentence of 36 months.

Federal law also prohibits insurance fraud. A conviction for insurance fraud in federal court could result in harsh sentences as well.

Defenses Against Insurance Fraud Ohio Charges

The facts of your case will dictate which defenses you should pursue. Your defense may involve proving that you filed a valid claim. Hopefully, any errors investigators made that led to you facing unjust charges would lead to a dismissal of your case before trial. If not, you could present evidence of your innocence at trial. 

Another potential defense you have relates to your lack of intent to defraud an insurance company. The prosecution has the burden to prove you had an intent to commit fraud. Showing the jury you had no intention of committing fraud could lead to an acquittal. 

Finally, you could argue to the jury that the prosecution failed to prove its case against you. The prosecution always has the burden of proof to convince a jury of your guilt beyond a reasonable doubt before it can convict you.

Defense Against Charges Alleging Insurance Fraud in Ohio

Gounaris Abboud is one of Ohio’s premier criminal defense firms. Contact us today or call us at 937-222-1515 to speak with one of our award-winning Ohio criminal defense lawyers if you have questions concerning Ohio insurance fraud.

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