Insurance Fraud

Make no mistake. Prosecutors and Assistant District Attorneys from New York City (Manhattan, Queens, Bronx and Brooklyn) to the suburban counties in Westchester and Rockland are aggressively investigating, arresting and indicting those individuals who perpetrate any type of fraud. In New York City and beyond, one of those frauds and white collar crimes that criminal lawyers are seeing more of is the crime of Insurance Fraud as set forth in New York Penal Law 176.10 through 176.30. In fact, New York criminal defense attorneys experienced in white collar and fraud crimes are not just seeing and uptick in the various offenses associated with Insurance Fraud, but are seeing judges willing to impose sentences with significant terms of incarceration and jail.

Generally speaking, you are guilty of Insurance Fraud in the Fifth Degree (New York Penal Law 176.10) if and when you commit or perpetrate an insurance act that is deemed fraudulent. This base level offense that is incorporated into the more serious felony crimes is an “A” misdemeanor punishable by up to one year in jail.

• Insurance Fraud in the Fourth Degree –New York Penal Law 176.15
• Insurance Fraud in the Third Degree –New York Penal Law 176.20
• Insurance Fraud in the Second Degree –New York Penal Law 176.25
• Insurance Fraud in the First Degree –New York Penal Law 176.30

Because that definition of this crime as established by the legislature in New York is fairly vague, it is important to understand some of the key terms in this crime to better grasp not only whether your conduct is criminal, but what defenses you and your criminal defense attorney might pursue.

Fraudulent Insurance Act

A fraudulent insurance act is defined as any act committed by an individual with the intent to defraud. In doing so, this person must either present, cause to be presented, or prepare a written statement either as part of or in support of any application for insurance, proof of self insurance, a claim of payment and other documents. The accused must also commit this act knowing or under the belief that this written statement will be presented to or by an insurer whether real or purported. Additionally, the accused must also know that the written information contains materially false information concerning a material fact or that the written information will conceal the material fact by misleading the person(s) who receive the information.

Fraudulent Health Insurance Act

Very similar to the definition of a fraudulent insurance act, a fraudulent healthcare insurance act addresses membership, enrollment and coverage in a health care plan. Additionally, an “application for the issuance of a health insurance policy” is also subject to this definition.

Insurance Fraud, regardless of the degree, rarely is a stand alone crime. That is, the end game and the offenses perpetrated to get there incorporate additional criminal activity. For example, a person seeking to obtain money and who fills out paperwork fraudulently may face Grand Larceny charges and allegations of the falsification of certain records. Although not a complete list of offenses, the following are common felony charges contained in indictments alleging New York Insurance Fraud:

• Enterprise Corruption
• Grand Larceny
• Forgery
• Falsifying Business Records
• Offering a False Instrument for Filing

As proof that Insurance Fraud is often connected to Grand Larceny, both statutes mimic each other in terms of the amount of the theft and the degree of the crime. Like Grand Larceny, Insurance Fraud is punishable as a misdemeanor by up to one year in jail and as much as twenty five years in prison if the offense committed is the “B” felon of Insurance Fraud in the First Degree.

For additional information on White Collar crimes in New York, follow the respective links. A wealth of information on these and other crimes can also be found by searching the New York Criminal Lawyer Blog.

Call the New York criminal defense attorneys and former Manhattan prosecutors at (212) 312-7129 or contact us online today