What is Insurance Fraud?
Insurance fraud generally involves providing false information (or omitting material information) or making false claims to an insurance company for the purpose of obtaining a benefit. Insurance fraud is prosecuted at both the state and federal levels, generally dependent on the amount of the loss and the complexity of the alleged fraud. There are two general forms of insurance fraud alleged in Texas – property/casualty insurance fraud and state healthcare benefit fraud. State insurance fraud is prosecuted by county District Attorney’s Offices. Federal insurance fraud is prosecuted by the United States Attorney’s Office.
Contact an Insurance Fraud Attorney in Houston for more information. Our insurance fraud lawyers in Houston have extensive knowledge of the prosecution and defense of insurance fraud charges and defends individuals charged with insurance fraud in state and federal courts.
Insurance Fraud in Texas
Property/casualty Insurance Fraud
Property/casualty insurance fraud in Texas is generally investigated by the Texas Department of Insurance, though it may also be investigated by local police agencies. Insurance fraud in Texas is prosecuted under Chapter 35 of the Texas Penal Code. The range of punishment for state insurance fraud charges is tied to the amount of the alleged loss. Under Texas law, an insurance fraud offense is classified as:
- a Class C misdemeanor if the value of the claim is less than $100;
- a Class B misdemeanor if the value of the claim is $100 or more but less than $750;
- a Class A misdemeanor if the value of the claim is $750 or more but less than $2,500;
- a state jail felony if the value of the claim is $2,500 or more but less than $30,000;
- a felony of the third degree if the value of the claim is $30,000 or more but less than $150,000;
- a felony of the second degree if the value of the claim is $150,000 or more but less than $300,000; or
- a felony of the first degree if the value of the claim is $300,000 or more.
Additionally, insurance fraud is a felony of the first degree if there an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.
State Healthcare Fraud
The Health and Human Services Commission (HHSC) Office of Inspector General investigates waste, abuse, and fraud in all health and human services programs in the State of Texas.
In the event that someone is convicted of insurance fraud in Texas, the court is legally required to order the person convicted to pay restitution, including court costs and attorney’s fees, to an affected insurer.
Federal Insurance Fraud
The federal government generally prosecutes insurance fraud where the loss amounts are high, the mechanisms for committing the alleged fraud are complex, or the scale of the alleged fraud is large.
The range of punishment for federal insurance fraud varies considerably depending upon the offense charge and the amount of the alleged loss. Many federal criminal offenses related to insurance fraud are found in 18 U.S.C. Chapter 47, and other common statutes of prosecution include mail and wire fraud under 18 U.S.C. Chapter 63.
Premium diversion is the theft of insurance premiums, and is a common type of federal insurance fraud. The scheme often involves an insurance agent’s failure to send premiums to an underwriter, instead keeping the money for personal use. An additional form of common premium diversion involves the sale of insurance without a license, the collection of premiums, and the failure to pay claims.
Fee churning involves a number of intermediaries taking commissions using reinsurance agreements. An initial premium is reduced by repeat commissions until the funds used to pay claims have been exhausted. The company paying the claim is often a shell, and the government will attempt to prove that there was never any intent to pay the claim.
Medicare and Medicaid Fraud
Medicare and Medicaid fraud generally involve the billing of government providers by doctors and healthcare workers for benefits not actually received by patients. In these cases, the government often intends to establish that Medicare or Medicaid paid for claims that were either exaggerated or entirely false.
Insurance Fraud Defense
Effective defense of an insurance fraud case requires granular review of the evidence associated with the allegations as well as an understanding of the law under which an individual or company is being prosecuted.
Our firm has the experience and knowledge necessary to effectively defend individuals charged with insurance fraud in state and federal courts. When possible, retaining an attorney during the investigative stage of a potential criminal prosecution for insurance fraud may mean the difference between being charged and the investigation being terminated.
David is one of the most polished, even tempered attorneys I’ve ever met. I was the defendant on a spurious criminal case and he carefully dissected each unsubstantiated allegation and was able to refute the basis for the charge itself (which was the intent to commit a crime). I have to say that he really made the prosecuting attorney look foolish by carefully researching and laying out the facts combined with his patient, even tempered demeanor. I also appreciated the fact that he knew the behind the scenes political motivations for why the prosecution in the D.A.’s office acted so illogically-he knows these people and their work environment, so he was able to use this to craft a winning strategy to get my case dropped.J.B., charged with Felony
“David is a consummate professional. Through a normal background check I found out I had a very old warrant, I attempted to call the county and they would’t even talk to me. It could have cost me my job. I contacted David (one of the challenges is I live 500 miles away); and he secured a dismissal the next day, saving my career. He cut right through the red tape. I’d highly recommend David to anyone!”R.B., charged with Misdemeanor
“I highly recommend criminal defense attorney David Nachtigall. While he represented my son, David consistently displayed a calm and professional demeanor, careful attention to detail, and thoroughly researched every aspect of a very complex and challenging criminal case. His ability to deduct the truth was commendable despite the complainants who kept changing their story. I am thankful we had David on our side. His previous experience working in the DA’s office was an advantage in understanding how the courts worked. I especially appreciated his compassion to stay in touch with us and that he was easily reachable when we had questions. If you need an attorney that will truly listen and fight for you, I recommend David Nachtigall.”P.T., parent of child charged with Felony
“David Nachtigall is a true professional. He handled my case (a second degree felony) with such expertise that the charges were dropped. His experience as a former prosecutor proved to be a tremendous asset. He kept me well informed and provided much needed personal support. I highly recommend David for any legal need you may have.”P.S., client charged with Felony
“I was recently charged with assault on a peace officer which is a felon charge. I have never been in trouble with the law in my life. I was raised in a strict catholic house I was at the wrong place at the wrong time. I hired David after dealing with a bad lawyer. He picked up the slack with no problem. David did everything in his power to get the charges dropped. I left with a misdemeanor charge and 6 months probation. David answered ALL of my phone calls & emails. He showed up to every court setting and didn’t send anyone for him. I would highly recommend David to anyone.”J.U., client charged with Felony
“David Nachtigall was my attorney for a DWI that I received in December of 2013. He really did a great job on my case. He was always very polite, prompt, and diligent when dealing with any questions that I had and he always took the correct steps to accomplish our desired outcome. Even though my case was stacked against me, he still was able to negotiate a DWI Pre-trial Intervention plea (which was the best and most realistic outcome considering the circumstances). Just to make things clear, the deal I received is not one that is easily ascertained. In fact, it took two tries to receive it. However, thanks to Mr. Nachtigall’s hard work and persistence, the deal went through. He never kept me in the dark about anything in reference to my case, he was not difficult to contact, and he always returned my phone calls as soon as possible or as soon as he had an answer to any question I asked (all of which are increasingly rare qualities in a busy lawyer). I can’t thank him enough for his help, and I would recommend David Nachtigall to anyone in need of a great, hard-working lawyer who knows how to get things done efficiently and effectively.”J.C., client charged with Misdemeanor
“I was recently traveling on business in Houston and was caught with a tiny amount marijuana. All it takes in Texas is half a joint and you are in a world of hurt. Dumb mistake on my part. Let me be the first to advise everyone in a similar situation, you will need strong representation. The Houston court system is beyond challenging and unbelievably confusing. What I thought was no big deal could’ve meant losing my license, probation, and possibly more jail time. Typically people hate attorneys, David saved me in a huge way. He treated me like a friend and always kept me posted on the status of my case. He was willing to work with me due to my work schedule and he came to his office, before it even opened, to meet me. Because of his experience and persistence my case was dropped. I am so thankful I found him and would highly recommend his service. Trust me, you will not be disappointed.”J.W., client charged with Misdemeanor
“Within my industry I consult with many lawyers and whilst on a business trip to Houston I required legal counsel and David was recommended to me. Initially David’s age surprised me; as it did not reflect his wealth of experience, local contacts and immediate control that he took of my case and me. David promptly providing sound, logical and concise legal counsel which demonstrating a comprehensive understanding of the local system and the law. David has great integrity and a supreme confidence born from experience. A quiet man but with a firm, resolute character that enabled a professional court demeanour that when coupled with his succinct legal strategy provided for a most successful conclusion in court – Thank you David. I vouch for and strongly recommend David services, he is great lawyer.”J.G., client charged with Misdemeanor
“David was the first and only person I considered calling for legal advice for a friend in an unusual and complicated situation. His advice was spot-on accurate and the best solution. David is not only one of the smartest lawyers I know but he also has a unique grasp of the nuances involved in working with different personalities and negotiating on behalf of them. He can quickly synthesize various outcomes and options into a well-defined solution. He does it all with integrity, clarity and confidence that I’d want representing myself or a loved one.”B.S., client under Felony Investigation
“Mr. Nachtigall is an exemplary attorney. Overall, he was always responsive to the various amount of questions I had, also he kept me informed on how things were looking during my case. I have spoken to plenty of attorneys, but Mr. Nachtigall seemed to stand out for his sincerity, his willing to make your case his responsibility and maintaining a positive attitude that seem to be hard to find nowadays.”A.R., client charged with Felony
“David went above and beyond to help me in defense of a DWI charge. With his background as a prosecutor, he already knew the ins and outs of navigating through the process and was able to get me a better deal than I otherwise would have received. His hard work, open communication, dedication and intelligence are all very valuable for anyone in an unfortunate situation like I was. I couldn’t be more pleased with his representation and would definitely recommend him to anyone considering hiring an attorney.”charged with Misdemeanor
“David is among an elite group of not only criminal defense lawyers, but lawyers at large, with the skill, experience and temperament to deliver results in matters of the highest stakes.”Attorney #1
“I worked with David at the Harris County District Attorney’s office here in Houston. I have personally watched David prepare for and try two murders and I have personally tried a family violence case with David. He is at his soul a phenomenal trial lawyer and a tireless preparer. He is ready when his case is called by the judge and God help you if you are the opposing counsel and you are unprepared for David. He is widely regarded in the criminal court house of Houston as a first rate advocate and is known to have a vast array of experience covering criminal matters from misdemeanor to felony.”Attorney #2
“I have known David Nachtigall for more than sixteen years. David is hard-working, creative, and very intelligent. He maintains well-grounded perspective and offers insight and common sense. David has the ideal background as an honors graduate from the University of Texas School of Law, a seasoned prosecutor, and a board-certified criminal attorney. He is an eloquent, charismatic, and experienced trial lawyer who is smarter than his competition—both the criminal defense attorneys and the prosecutors. David should be your first consideration for a criminal matter in Texas.”Attorney #3
“I highly recommend David Nachtigall. Without a doubt, David will be sure to handle all of your needs with the care you deserve. David is an exceptional attorney who is dedicated to providing his clients with timely and thorough representation. David is dedicated to bringing the best results for his clients, guiding them through every step of the way.”Attorney #4
“I have known David for over 20 years and there is no one in whom I have more confidence and trust. David’s counsel and advice is one of the big reasons that I became a lawyer. I’m so glad that David has struck out on his own. I now have a go-to attorney to refer friends, family, and professional contacts when I’m approached with a criminal law issue. David does his homework and always makes sure he’s the smartest person in the room. He’s a smart, professional and an incredibly skilled attorney.”Attorney #5
“David is an intelligent, thoughtful problem solver who brings a creative approach to each issue a complex case presents. I thoroughly enjoyed working with him, and would highly recommend him for both criminal defense and business cases.”Attorney #6