Insurance Fraud

New York Penal Law 176.00 et seq describes the definition of New York insurance fraud and its various gradations. Penalties for insurance fraud can be severe depending on the amount that is alleged to be in controversy. Insurance fraud can range anywhere from a class A misdemeanor to a class B felony, with maximum penalties of 1 through 25 years of incarceration. Additionally, if a person commits insurance fraud more than once within a 5 year period, regardless of the amount in controversy, a charge of aggravated insurance fraud may be imposed as well. Aggravated insurance fraud is a class D felony that carries with it the maximum penalty of 7 years in prison.

If you have been accused of insurance fraud call our experienced New York Criminal Attorneys today for a free consultation.

Generally speaking, Insurance fraud is committed when a person with knowledge and intent to defraud causes materially false information to be entered into an application or claim for commercial insurance. Additionally, insurance fraud is also committed when a person enters materially false information into a health insurance or personal insurance application or claim.

Passing a specific law to deal with insurance fraud, apart from other forms of fraud was premised upon New York’s legislature’s attempt to protect insurance companies from fraudulent arson, car theft, and staged accident no-fault claims. This problem was particularly severe in Bronx county in the late 70s and early 80s.

Nearly every prosecutors’ office in the state has investigated such conduct. According to insurance companies, insurance fraud schemes have become a moneymaking criminal scam allegedly driving up the costs of insurance of all types. Insurance companies would have the public believe that there is a vast anti insurance conspiracy against insurers and the tendrils of that conspiracy reach everyone from attorneys, doctors, police on the take, professional plaintiffs, fake property management companies, corrupt nurses, fake accident victims, paid witnesses, and many other illicit professions intent on making money off insurance companies.

On the other hand, there are many honest and hard working health care providers, business owners, and car drivers who file absolutely legitimate claims on a daily basis, that are aggressively pursued by insurance company “Special Investigative Units” or SIU units, generally made up of former military personnel, private investigators, and off duty, or retired police. These SIU units often bully and intimidate people and corporations into withdrawing legitimate claims merely because the claim would be expensive for the insurance company to pay or because the insurance company paid out a large claim to that party before. Furthermore, these SIU units can cause claimants to accidentally admit to what may be evidence of insurance fraud. This may trigger further investigation by district attorney’s offices that are specially devoted to one thing, prosecuting insurance fraud.

One may ask what the distinction between insurance fraud and larceny is, since essentially, the final goal of both crimes is to steal. The major distinction between the two crimes is that the crime of insurance fraud is completed upon its attempt, the execution of the documents, rather than the theft actually taking place while larceny actually requires the victim to be dispossessed of their property. The fraudulent applications or claims do not need to actually be paid, and the amount that the prosecution believes the defendant sought to fraudulently extract from the insurance company is what is used to determine the severity of the charges.

If you or someone you know is being investigated or prosecuted for insurance fraud call our team of experienced New York Criminal Attorneys. We may be able to help get your charges dismissed or reduced. Call us today for a free consultation.

Just as with any type of health care fraud, insurance fraud is an incredibly serious charge in New York state. While health care fraud focuses on the provider, insurance fraud focuses on the person who is the recipient of the insurance and their choice to submit false information. While there are five degrees of this offense that can be charged, only the lowest degree is a misdemeanor and not a felony. If you find yourself facing any degree of insurance fraud, call our experienced team of New York criminal attorneys now for a free consultation.

While the statute itself is simple, stating only that when a person commits a fraudulent insurance act, they are guilty of insurance fraud in the fifth degree, it is important to know what the legislature has defined that to mean. “Fraudulent insurance act” has a two-part definition. First is if any written statement is submitted in support or as part of an application, rating, claim or other benefit and knowingly contains false information that deals with a material fact of conceals a material fact and is done so with intent to defraud the insurer. Second is if any written statement or physical evidence that is submitted in support or as part of an application for health insurance, allowance of coverage for services of a private or public health plan or claim for benefit and contains false information related to a material fact or conceals such type of fact.

One degree higher of this offense is charged as a class E felony and applies when a person commits a fraudulent insurance act and withholds or obtains property valued more than $1,000. As with any felony conviction, this could lead to the loss of a person’s right to vote as well as be eligible for other types of state benefits in the future so it is important that these charges be handled by a team that will do their best to obtain the most favorable outcome. Under the same conditions as just described, if the among of property wrongfully withheld or obtained is above $3,000 in value, the charge is now insurance fraud in the third degree and a class D felony. Property in this instance does not just mean land or physical things, money can be considered property as well meaning that in committing the fraudulent insurance act a person receives a cash payment, the amount of that cash payment would be considered the property wrongfully obtained.

The second highest charge, insurance fraud in the second degree, applies to the same conditions as in the fourth and third degree, but when the amount is above $50,000 in which it is now a C felony. At its highest charge, a B felony applies when the property exceeds $1,000,000. Additionally, there is the charge of aggravated insurance fraud which applies when a person has previously been convicted of insurance fraud in any degree within the previous five years of their current offense. This charge is an automatic class D felony regardless of the degree of the previous and current offense.

As the majority of these offenses could result in a felony conviction, it is incredibly important that you reach out now for a free consultation with our experienced team of New York criminal attorneys to discuss what options are available to you.