Insurance fraud is not just a New York problem, it is a national problem. While this column generally focuses on trends in New York, it can be helpful on occasion to review conduct from across the country. Such a national review reveals that insurance carriers are taking an aggressive stance against insurance fraud and are filing actions seeking to recover compensatory, punitive, or treble damages; insurance payments they previously paid; and even their attorney’s fees and court costs. Defendants assert a wide range of defenses in response. For the most part, however, insurance companies that are able to prove fraud by policyholders, health care providers, personal injury plaintiffs, or others who have improperly received funds have successfully obtained judgments for the amounts that had been fraudulently disbursed.

Indeed, in State Farm Mut. Automobile Ins. Co. v. Lincow,1 the plaintiff insurance carriers were awarded more than $4 million by a Pennsylvania jury in a case in which they asserted fraud claims and claims under RICO against certain health care providers; their damages were trebled for a total award of $12.1 million in their favor. Another example is State Farm Mut. Automobile Ins. Co. v. Physicians Injury Care Center Inc.,2 in which the U.S. Court of Appeals for the Eleventh Circuit recently affirmed a jury verdict in excess of $4 million against a medical provider for a sham course of treatment designed to exhaust the patients’ insurance benefits.

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