Insurance Fraud

Florida has become one of the most aggressive states in the country in prosecuting insurance fraud, and the consequences for those charged are severe. A single accusation under Florida Statute § 817.234 can lead to felony charges, years in prison, and the permanent loss of a professional license. If you have been charged with insurance fraud or are under investigation, the clock is already running against you.

At the Wiseman Law Firm, we represent individuals accused of insurance fraud across Central Florida. Attorney Simon Wiseman is a former Orange County prosecutor with over 26 years of experience and more than 100 jury and non-jury trials, and our firm has handled fraud cases across a wide range of industries, including property claims, roofing disputes, and health care billing. Fraud charges are serious, but a charge is not a conviction. If you are facing accusations related to fraud in Florida, you need an aggressive criminal defense attorney in your corner immediately.

What Florida Law Says About Insurance Fraud

Florida defines insurance fraud broadly, and prosecutors use that breadth to their advantage. Under Florida Statute § 817.234, a person commits insurance fraud when they knowingly present or prepare a false, incomplete, or misleading statement in connection with an insurance claim, with the intent to deceive an insurer. This definition can apply to property damage claims, health care billing, auto accidents, and beyond.

The penalties depend on the dollar amount alleged to be involved in the scheme. A violation involving less than $20,000 is charged as a third-degree felony. When the amount is $20,000 or more but less than $100,000, it becomes a second-degree felony. Allegations involving $100,000 or more are classified as a first-degree felony, carrying up to 30 years in prison. These are not minor charges, and the range of conduct that can trigger an investigation is wide.

How Cases Are Investigated and Charged

The Florida Department of Financial Services operates a Division of Criminal Investigations specifically dedicated to insurance fraud enforcement, and its case volume has grown significantly in recent years. Investigations can be triggered by an insurer filing a suspicious activity report, a competitor filing a complaint, a disgruntled employee, or a broader state enforcement sweep. Defendants are often unaware they are under investigation until charges are filed or a search warrant is executed.

Roofing contractors, medical providers, auto repair shops, adjusters, and individual policyholders have all been targets of these investigations. The State of Florida’s enhanced enforcement environment means that disputes that might once have been handled civilly can now result in criminal prosecution.

Common Defenses in Florida Insurance Fraud Cases

Prosecutors bear the burden of proving every element of the charge beyond a reasonable doubt, including that the defendant acted knowingly and with intent to defraud. That intent element is often where a strong defense begins. Many accused defendants made honest mistakes, relied on advice from contractors or billing companies, or submitted information they genuinely believed was accurate.

Several defense strategies may apply depending on the facts of a case:

• Lack of intent: The prosecution must prove deliberate deception, not negligence or error. Evidence showing the defendant relied on estimates, documentation, or third-party guidance can directly undercut this element.
• Entrapment or improper investigation: If law enforcement used improper tactics to induce a transaction, that conduct may form the basis of an entrapment defense.
• Insufficient evidence: Many fraud cases rest on circumstantial evidence, inflated projections, or the testimony of cooperating witnesses with their own interests. Challenging the quality and reliability of that evidence is a core part of the defense.
• Unlawful search or seizure: If investigators obtained documents, electronic records, or communications through procedures that violated the Fourth Amendment, suppression of that evidence may be available.

Each case involves a unique set of facts, and the right defense strategy depends on how charges were built and what evidence the state of Florida actually holds.

Why Insurance Fraud Cases Require a Trial-Tested Attorney

Insurance fraud prosecutions are document-heavy, technically complex, and often involve multiple defendants or overlapping state and federal charges. White-collar criminal defense requires a lawyer who knows how to dissect financial records, work with expert witnesses, navigate pretrial motions, and read a jury. The same skills that make Simon Wiseman effective in serious felony cases also make him well-suited to handle the elevated stakes of fraud allegations.

Insurance fraud charges are sometimes pursued alongside related allegations, including mortgage fraud, identity theft, or an organized scheme to defraud under Florida Statute § 817.034. When prosecutors layer charges, the potential sentencing exposure multiplies. Having an attorney who understands how these charges interact and how to fight them simultaneously is critical.

What to Do If You Have Been Charged With Insurance Fraud in Florida

The single most important step you can take after being charged or learning you are under investigation is to contact a criminal defense attorney before speaking with investigators, insurers, or anyone else involved in the case. Anything you say can be used against you, and the window to influence how a case is built is narrow.

Do not attempt to explain yourself to law enforcement, return calls from investigators, or provide documents in response to informal requests without legal representation. Do not contact witnesses, insurers, or co-defendants on your own. Preserve all records you have access to and follow the instructions of your attorney regarding document retention.

Contact the Wiseman Law Firm for Insurance Fraud Defense in Florida

When the stakes are this high, you need a defense attorney who has seen the inside of the courtroom from both sides. Simon Wiseman spent years as a prosecutor before dedicating his career to criminal defense, and that experience gives our firm a precise view of how these cases are built and where they can be challenged.

If you or someone you know is facing insurance fraud charges anywhere in Central Florida, do not wait. Contact our office today through our online contact form to schedule a confidential consultation with our legal team.