Insurance Fraud and Forensic Investigations

Our Insurance Fraud and Forensic Investigations attorneys provide comprehensive legal, advisory, consultative and litigation services to industries and organizations subject to attack or otherwise victimized by organized schemes to defraud. Morrison Mahoney’s insurance fraud and forensic detection, prevention and affirmative recovery practice group is comprised of highly skilled and experienced litigators, including former prosecutors and industry-recognized insurance defense attorneys, with a proven track record of developing fraud prevention plans, identifying patterns of fraud through the utilization of forensic tools, civilly prosecuting fraud rings and, where appropriate, referring matters to federal, state and/or local law enforcement agencies for investigation and criminal prosecution. 

The Insurance Fraud and Forensic Investigations Practice Group provides an array of investigative, preventative and litigation services, including prosecuting cases involving fraud, commercial bribery and complex schemes to defraud. Members of the Insurance Fraud and Forensic Investigations Practice Group have successfully prosecuted numerous cases under the federal Racketeer Influenced and Corrupt Organizations Act (“RICO”) and state analogues, anti-kickback statute and common law fraud.

Morrison Mahoney's team of attorneys has litigated insurance and healthcare fraud actions in Massachusetts, New York, and throughout the United States. In additional they have provided advisory opinions concerning emerging schemes to defraud commercial organizations and guidance regarding the best course of action to minimize exposure to fraud.

Commercial Enterprise Fraud

With vast civil and criminal prosecutorial experience, Morrison Mahoney is well-equipped to represent clients victimized by fraud or other schemes for profit. We utilize the most effective forensic methods and legal theories to recover losses attributable to fraud. If the facts require criminal prosecution, working with the client, we can facilitate contact with the appropriate local, state and federal law enforcement agencies to present cases for prosecution.  In the civil arena, Morrison Mahoney has successfully recovered large judgments and obtained settlements for its clients, utilizing sophisticated techniques to prosecute fraudulent enterprises and nefarious individuals engaged in fraud. 

Services Provided

Morrison Mahoney’s Insurance Fraud and Forensic Investigations team offers the following representative services:     

  • conducting first-party and third-party examinations under oath
  • conducting forensic investigations relating to complex schemes to defraud
  • drafting and preparing training manuals and fraud prevention to comply with applicable law, such as section 409 of the New York State Insurance Law
  • facilitating criminal prosecution of fraudulent claimants by acting as a liaison between its clients and law enforcement agencies
  • drafting and submitting reports with the appropriate agencies, such as the New York State Insurance Frauds Bureau for prosecution
  • commencing civil law suits to recover compensatory, punitive and, in some cases, treble damages, based on common law fraud, RICO and other claims sounding in tort and contract; 
  • prosecuting health insurance fraud, medical mills and organized rings, staged theft losses, auto theft and arson;
  • defending first-party and third-party bad faith litigation and coverage litigation issues
  • working with special investigators to achieve favorable dispositions
  • pursuing restitution for payments based on fraudulent claims
  • creating reviewing and improving anti-fraud systems
  • advising clients on compliance with federal, state and local reporting requirements concerning fraudulent claims
  • tailoring anti-fraud systems to minimize exposure to civil liability;
  • apprising clients of new trends, specific to the relevant industry, and
  • providing summaries of recent federal, state and local legislative enactments

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