Insurance fraud in Florida is prosecuted under section 817.234. The conduct it reaches is presenting or preparing a statement in support of an insurance claim, with intent to injure, defraud, or deceive the insurer, while knowing the statement contains false, incomplete, or misleading information that is material to the claim. It sweeps in claims after hurricanes, floods, fires, car crashes, and injuries, which is why ordinary homeowners and medical providers end up charged alongside organized rings.
One feature shapes the whole charge: Florida courts have held there is no requirement that the insurer relied on the statement. Making the false or misleading statement with the required intent is enough, even if the company never paid, which moves the entire fight onto intent and knowledge.
How the Degree Is Set
Insurance fraud is graded by the value of the property involved in the violation, on a three-tier scale. The 2025 amendment to the statute tightened sentencing, added triggers for upward departure, and expanded the window in which the State can bring charges, so older claims can surface years later through an audit or a referral.
| Value involved | Degree | Maximum |
|---|---|---|
| Less than $20,000 | Third-degree felony | Up to 5 years |
| $20,000 to under $100,000 | Second-degree felony | Up to 15 years |
| $100,000 or more | First-degree felony | Up to 30 years |
There is no reliance requirement. Attorneys, physicians, and other practitioners who knowingly assist or conspire can be charged with a third-degree felony, and a health care practitioner convicted on a PIP-related claim loses the license for five years and cannot receive PIP reimbursement for ten.
Earlier in my career, my practice was almost entirely white-collar defense, including fraud cases, conspiracy charges, and a statewide racketeering prosecution. That work shaped how I read these files: where the money really moved, what the State can prove about intent, and where a paper case quietly falls apart. I defend the state-level side of these matters here in Florida. When a case is federal, or turns federal, I bring in or refer trusted federal co-counsel so you are covered on both tracks rather than caught between them. Learn more about my background.
Professionals Have More at Stake
For licensed professionals, the criminal case is only half the danger. A health care practitioner found guilty of insurance fraud tied to a personal injury protection policy loses the license to practice for five years and is barred from PIP reimbursement for ten. Attorneys and physicians who knowingly assist or conspire in a fraudulent claim can themselves be charged with a third-degree felony.
That means a doctor, a clinic owner, or a lawyer facing one of these cases is defending a livelihood on a parallel track in front of a licensing board, on a different timeline from the criminal court. The two have to be handled together, because an admission or a plea in one can be fatal in the other.
The Common Fact Patterns
Insurance fraud charges cluster around a handful of scenarios. Property claims after a hurricane, a fire, or a pipe burst draw scrutiny when an estimate looks inflated or a loss looks staged. Auto and PIP cases involve alleged staged accidents, treatment that is claimed but not provided, or billing that does not match the care. Provider cases involve upcoding, unbundling, or billing a usual-and-customary rate while waiving the copay. Each pattern has its own proof and its own weak points.
What ties them together is how easily an ordinary person gets swept in. A homeowner who trusted a public adjuster, a patient caught up in a clinic’s billing practices, or a contractor whose paperwork was sloppy can find themselves charged alongside the people who designed and ran a scheme. The 2025 amendment made these cases more aggressive, with tighter sentencing and a longer window to charge, so claims from years ago can resurface. Separating the person who relied in good faith from the person who designed the fraud is the heart of the defense.
How an Insurance Fraud Case Is Defended
Because there is no reliance element, the defense runs at knowledge and intent. A claim that was wrong is not a claim that was fraudulent, and good-faith reliance on a contractor, an adjuster, or a public adjuster who prepared the numbers is a recognized defense. Damage estimates are inherently subjective, and overestimation, standing alone, is not fraud unless the State can prove the figure was known to be false and submitted to deceive.
The value tier is the other lever, because it sets the degree and the sentence, and how the State built the figure is often disputable. Where a homeowner relied on professionals, where the alleged falsehood is really a difference of opinion, or where the paperwork passed through several hands, the intent the State needs gets harder to prove. For providers, coordinating the criminal defense with the licensing defense is part of the strategy from day one.
Common Questions
What is insurance fraud in Florida?
Under section 817.234, it is presenting or preparing a statement in support of an insurance claim with intent to injure, defraud, or deceive the insurer, knowing the statement contains false, incomplete, or misleading material information. It covers claims after storms, fires, accidents, and injuries.
Does the insurer have to rely on the statement?
No. Florida courts have held there is no reliance requirement. Making the false or misleading statement is enough, which makes intent and knowledge the central battlegrounds rather than whether the company paid.
How are the penalties set?
By the value involved. Less than $20,000 is a third-degree felony, $20,000 to under $100,000 is a second-degree felony, and $100,000 or more is a first-degree felony. A 2025 amendment tightened sentencing and expanded the time the State has to bring charges.
What happens to a medical provider's license?
A licensed health care practitioner found guilty of insurance fraud tied to a PIP policy loses the license to practice for five years and cannot receive PIP reimbursement for ten. That is why these cases have to be defended with the licensing consequences in mind from the start.
Is overestimating damage a crime?
Not by itself. Estimating storm or accident damage is often subjective, and many folks rely on contractors or adjusters for the numbers. Unless the State can prove you knew a figure was false and submitted it to deceive, overestimation alone is not fraud.
Related: White collar and fraud overview, Pre-file defense and asset forfeiture, Scheme to defraud and organized fraud, Racketeering and RICO, and About Rory Safir.
This page is general information about Florida law, not legal advice, and it does not create an attorney-client relationship. These offenses are governed by chapters 817, 831, 895, and 896, and section 775.0844, Florida Statutes, and many of the same facts can also draw federal charges, so the exposure should be confirmed against current state and federal law. Every case turns on its own facts, and past results do not guarantee a similar outcome.
