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Is it insurance fraud for company to issue benefits to employee who is not qualified under insurance company polices?

Portland, OR |

company mislead insurance company so a person who otherwise would not be qualified recieved full medical benefits. if caught who gets in trouble the employee, the business, the insurance agent who pushed it through for the business owner due to their friendship? what if the employee didnt know qualifications didn't meet properly does that affect liability? what is this kind of penalty for this type of thing?

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Attorney answers 1


There are so many contained in your question, that it is very difficult to answer or provide other guidance on. The biggest issue is why you believe "employee is not qualified"--I don't know what this phrase means. Your question suggests health insurance, which employers are typically allowed to offer to any employee as part of compensation. An employee can negotiate new compensation, which might include health insurance not previously offered, and there is nothing fraudulent about that process. Also, most workplace health insurance has "open enrollment" periods when anyone can sign on without a need to "qualify." I am detecting that there is some other unfairness or inappropriate workplace conduct that concerns you. But nothing in your question suggests insurance fraud.

This answer is for general discussion purposes only, and my answer does not create or imply an attorney-client relationship between the questioner and me. I do not represent any person without a conflict check and written agreement.

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