Reporting Insurance Fraud in Pennsylvania

What is Insurance Fraud?

Insurance fraud occurs when an insurance company, agent, adjuster or, consumer commits a deliberate deception in order to obtain an illegitimate gain.

It can occur during the process of buying, using, selling, or underwriting insurance and can fall into different categories from individuals committing fraud against consumers to individuals committing fraud against insurance companies. 

Fraud not only inflicts extra costs on insurance companies, but it also financially impacts consumers and businesses. The Coalition Against Insurance Fraud indicates that fraud costs businesses and consumers $308.6 billion a year.  Additionally, the FBI estimates insurance fraud costs the average family between $400 and $700 a year in premiums.

In Pennsylvania, insurance fraud is a felony, punishable by up to 7 years in jail and fines of up to $15,000. It's also illegal to assist or conspire with someone else to commit insurance fraud.

• Submitting claims for injuries or damages that never happened, services never rendered, or equipment never delivered
• "Padding" or inflating actual claims to get a higher payment,
• Staging an incident, such as a collision, fire, or break-in (In addition to the cost of the fraud itself, this type of fraud can also result in first responders or others being injured or killed),
• Faking or exaggerating an injury,
• Fabricating receipts or bills requested by an insurer,
• Using someone else's identity or insurance information to get health care services,
• Giving false information, such as who was driving a vehicle or where an injury occurred,
• Attempting to get a better insurance rate by giving a false address or not reporting a property or car is used for business,
• Medical providers falsifying a diagnosis or performing unnecessary procedures for financial gain

How Does Insurance Fraud Impact You?

Insurance fraud is not a victimless crime. It ends up costing us all. The FBI estimates insurance fraud costs each of us between $400 and $700 a year in higher rates and premiums.

What Can You Do to Help?

If you suspect someone is committing insurance fraud, report it! To report insurance fraud in Pennsylvania, contact: The Pennsylvania Office of The Attorney General - Insurance Fraud Section.

For more information on insurance fraud, visit www.HelpStopFraud.org.