New York White Collar Crime: Insurance Fraud in the Fifth Through First Degree (NY Penal Law 176.10 – 176.35) & Your Criminal Defense

Chubb, Kemper, Allstate, Geico…the name of the insurance company makes no difference at all. It is your actions, regardless of the insurance provider, that may land you in an upstate prison cell for perpetrating Insurance Fraud. As we at Crotty Saland PC have said time and time again, we are available to assist our clients day or night. That being said, your best defense is not necessarily a top criminal defense firm, but knowing the law and keeping yourself from needing a New York criminal defense attorney in the first place.

Before dissecting the penal law, the following are some important definitions that are the basis to the charge of Insurance Fraud:

Section 176.05 Insurance fraud; defined

1. A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented to or by an insurer, self insurer, or purported insurer, or purported self insurer, or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of a commercial insurance policy, or certificate or evidence of self insurance for commercial insurance or commercial self insurance, or a claim for payment or other benefit pursuant to an insurance policy or self insurance program for commercial or personal insurance which he knows to: (i) contain materially false information concerning any fact material thereto; or (ii) conceal, for the purpose of misleading, information concerning any fact material thereto.

2. A fraudulent health care insurance act is committed by any person who, knowingly and with intent to defraud, presents, causes to be presented, or prepares with knowledge or belief that it will be presented to, or by, an insurer or purported insurer or self-insurer, or any agent thereof, any written statement or other physical evidence as part of, or in support of, an application for the issuance of a health insurance policy, or a policy or contract or other authorization that provides or allows coverage for, membership or enrollment in, or other services of a public or private health care plan, or a claim for payment, services or other benefit pursuant to such policy, contract or plan, which he knows to:

(a) contain materially false information concerning any material fact thereto; or

(b) conceal, for purposes of misleading, information concerning any fact material thereto.

Such policy or contract or plan or authorization shall include, but not limited to, those issued or operating pursuant to any public or governmentally-sponsored or supported plan for health care coverage or services or those otherwise issued or operated by entities authorized pursuant to the public health law. For purposes of this subdivision an “application for the issuance of a health insurance policy” shall not include (a) any application for a health insurance policy or contract approved by the superintendent of insurance pursuant to the provisions of sections three thousand two hundred sixteen, four thousand three hundred four, four thousand three hundred twenty-one or four thousand three hundred twenty-two of the insurance law or any other application for a health insurance policy or contract approved by the superintendent of insurance in the individual or direct payment market; and (b) any application for a certificate evidencing coverage under a self-insured plan or under a group contract approved by the superintendent of insurance.

The statutes for Insurance Fraud after the jump (notice how the Insurance Fraud statute mimics the loss element of the Grand Larceny statute)…
Section 176.10 Insurance Fraud in the Fifth Degree

A person is guilty of Insurance Fraud in the Fifth Degree when he commits a fraudulent insurance act.

Insurance Fraud in the Fifth Degree is a class A misdemeanor punishable by up to 1 year in jail. Section 176.15 Insurance Fraud in the Fourth Degree

A person is guilty of Insurance Fraud in the Fourth Degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of one thousand dollars.

Insurance Fraud in the Fourth Degree is a class E felony punishable by up to 4 years in prison. Section 176.20 Insurance Fraud in the Third Degree

A person is guilty of Insurance Fraud in the Third Degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of three thousand dollars. Insurance Fraud in the Third Degree is a class D felony punishable by up to 7 years in prison. Section 176.25 Insurance Fraud in the Second Degree

A person is guilty of Insurance Fraud in the Second Degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of fifty thousand dollars.

Insurance Fraud in the Second Degree is a class C felony punishable by up to 15 years in state prison. Section 176.30 Insurance Fraud in the First Degree

A person is guilty of Insurance Fraud in the First Degree when he commits a fraudulent insurance act and thereby wrongfully takes, obtains or withholds, or attempts to wrongfully take, obtain or withhold property with a value in excess of one million dollars.

Insurance Fraud in the First Degree is a class B felony punishable by up to 25 years in prison.

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