Washington Insurance Fraud Laws

In the state of Washington, insurance fraud can occur in several different ways including worker's compensation fraud, property fraud, and casualty fraud. Generally insurance fraud offenses can occur when someone tries to make money from insurance transactions through deception.

Examples of insurance fraud include:

  • Being billed for services or equipment you didn't receive
  • Offering free testing or screening in exchange for your Medicare number
  • Charging for filling out claim forms
  • A medical provider performing services that exceed what's medically necessary
  • Offering or accepting referral fees from another provider for the referral
  • Misrepresenting services that are billed to Medicare
  • Waiving the 20 percent coinsurance or deductible

Who Enforces and Prosecutes Insurance Fraud Laws?

The Washington State Office of the Insurance Commissioner and local prosecutors handle insurance fraud cases under the state's penal laws. The Feds can also prosecute insurance fraud under a number of criminal statutes including as "mail fraud," "criminal racketeering" or other federal offenses.

How do I File a Complaint Against a Washington Insurance Company?

You can file an online complaint against insurance carriers and discount health plan providers, including reporting suspected insurance fraud.

The following table highlights the main provisions of Washington's insurance fraud laws. See also Association of Certified Fraud Examiners, Fraud, Fraud and Financial Crimes, and Arson .

Code Section

Chapter 48.30A RCW

What is Prohibited

Knowingly lying about, or concealing an important fact in connection with a insurance claim or payment made under an insurance policy. Applies to issuing fake insurance policies and rate-fixing. Also includes conspiring to do any of the above.

Penalties

Gross Misdemeanor of Class C felony

Possible civil penalties including fines, revocation of business license, etc.

Who Can Be Prosecuted Consumers, Providers (such a doctor and auto repair shop), and Insurance Companies, Adjusters and others
Types of Insurance Fraud
  • Automobile Accidents and insurance
  • Health Care Claims
  • Insurance Applications
  • Medicaid
  • Disability Benefits
  • Unemployment Insurance
  • Workers' Compensation

Insurance Fraud Detection Reward Program

Individuals may apply for a reward for any tip that leads to an arrest and conviction.

• Mention the reward when reporting suspected insurance fraud.
• For property and casualty lines of insurance only
• Insurance professionals, law enforcement officers, perpetrator/co-perpetrator and crime victims are ineligible for a reward.

Examples of Insurance Fraud
  • False Worker’s Compensation claims
  • False or misleading property loss claims
  • Arson for profit
  • Staged car accidents for insurance settlements
  • Health care claims fraud
  • Falsely obtaining unemployment insurance benefits when you are working
  • Small accidents in collecting an insurance check without fixing vehicle
  • Home repair fraud
  • Stolen car scams
  • Unnecessary medical procedures

Enforcement Agency

If you feel you have been victimized by insurance fraud, here is some contact information that can help you:

  • Insurance Consumer Hotline at 800-562-6900

Because insurance fraud laws can sometimes get complicated, it may also be a good idea to consult an experienced criminal defense attorneys if you have questions about your specific situation.

Next Steps: Search for a Local Attorney

Contact a qualified attorney.