Insurance Fraud and Recovery

Holland & Knight's Insurance Fraud and Recovery Team is built on three principles:

• Our attorneys have an in-house understanding of clients' business operations.
• We exercise investigative skills that complement those of high-level law enforcement.
• When appropriate and necessary, we protect the rights of insurance carrier clients through litigation to recover the financial losses suffered as a result of unlawful acts and to stop the illegal behavior.

Healthcare fraud costs the United States about $68 billion each year, and property and casualty insurers lose at least $34 billion each year to fraud, according to industry data. Increasingly, insurance fraud has become a sophisticated, systemic enterprise with the large-scale participation of unethical providers and organized crime.

The magnitude and sophistication of fraud against insurers requires lawyers of equal sophistication and experience. The national Insurance Fraud and Recovery Team, a group of experienced litigators, focus almost all of their time on understanding fraud and helping clients recover misappropriated assets and payments made for fraudulent claims. Our team includes former prosecutors who have tried hundreds of cases to verdict and attorneys with decades of experience in complex commercial litigation and trials. Based on the number of lawyers and resources we dedicate to this area and the value of our recoveries and anti-fraud efforts, we are one of the leading law firms in the insurance fraud recovery space.

We also represent self-insured retailers, investors, trusts and individuals who are victims of large-scale fraud. In all cases, our approach is to lay the groundwork for recovery by investigating allegations and then pressing claims in the courts, if necessary.

What We Do

Our objective is to deeply understand the circumstances our insurer clients face when evaluating claims so that our team can identify fraud and unlawful efforts to obtain insurance benefits. We investigate all aspects of insurance fraud and litigate these issues in virtually all U.S. jurisdictions to recover the losses and stop the concerted actions to defraud our clients. 

Suspected fraud comes to our attention through a variety of avenues. Clients regularly uncover suspicious activity and payment patterns through the use of data analytics. Evidence often is data-driven, and we have broad experience using data analytics to quickly identify patterns and other indicators of fraud. Whistleblowers, tipsters, patients and insureds also inform clients of fraud, and we frequently manage such investigations based on information from these third parties. In all cases, we carefully lay the foundation of a case by implementing a thorough investigation, while always collaborating closely with clients' special investigation units (SIUs), many of which we have helped train. Our attorneys immerse themselves in our clients' internal processes and procedures, and we often teach investigative techniques to our clients' SIUs.

Counsel to America's Insurers

Holland & Knight represents some of the nation's largest healthcare and property and casualty insurance companies. Healthcare now represents almost a quarter of the U.S. GNP, and the opportunity for fraud is enormous. Our group was formed with the recognition that effective investigations and recovery require a deep understanding of the complex laws and regulations that govern healthcare reimbursement, licensing and reporting, as well as the protocols and culture of the industry and medical profession. While individuals continue to commit fraud, we have found that many schemes are large-scale criminal enterprises that mix legitimate care with illegal claims, referrals and other self-dealing. The practice of medicine grows more complex every day, and our attorneys familiarize themselves with the minutiae of diagnosis, treatment and reimbursement in order to recognize fraud. Our team has a deep understanding of the medicines involved in the claims that we are asked to review, and we have longstanding relationships with the nation's leading experts who guide the analysis of appropriate medical treatment.

Our long experience with many versions of fraudulent schemes allows us to help our clients establish prevention and detection programs and identify gaps in their protection and opportunities for exploitation. 

Staying Current with Innovation and Enforcement Tools

While lawmaking in Washington, D.C., receives the most attention, there are hundreds of state laws that affect our clients, and we follow those developments closely since many of our clients operate in multiple jurisdictions. On the state level, 116 fraud-related bills were introduced in 2018, and 33 passed, according to the Insurance Journal. The new laws address nearly every aspect of insurance fraud, and most will create new tools to prevent fraud or enable recovery. However, the laws also address insurer responsibilities, particularly in the area of data privacy, and we advise clients on how to use these investigative data in compliance with all state and federal laws.

Our Attorneys' Representative Matters

• Represented an insurance company in a Racketeer Influenced and Corrupt Organizations Act (RICO) fraud and deceptive trade practices claim in federal court, seeking more than $35 million from medical providers that billed for unnecessary procedures
• Represented a national insurance carrier in litigation to recover payments from an unlicensed medical provider that administered unnecessary treatment to insureds
• Represented a private equity firm in investigating a fraudulent scheme to induce it to invest in a healthcare software company
• Represented a national property and casualty insurer in the first lawsuit against a medical legal referral service under Florida's self-referral laws