N.Y. Penal Law § 176.05: Insurance fraud; defined

§ 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:

(a) 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 that such person 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; or

(b) 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 plan, or a claim for payment, services or other

benefit pursuant to such policy, contract or plan that such person knows

to:

(i) contain materially false information concerning any material fact

thereto; or

(ii) conceal, for the purpose of misleading, information concerning

any fact material thereto.

Such policy or contract or plan or authorization shall include, but

not be 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 (i) any application for a health insurance policy or contract

approved by the superintendent of financial services 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 financial services in the individual or direct payment

market; or (ii) any application for a certificate evidencing coverage

under a self-insured plan or under a group contract approved by the

superintendent of financial services.

2. A person who hires, requests, encourages, orchestrates, or invites

another individual to stage a motor vehicle accident, as that term is

defined in section 176.75 of this article, commits a fraudulent

insurance act, and the person who hired, requested, encouraged,

orchestrated, or invited the other to stage a motor vehicle accident

shall be deemed to have wrongfully taken, obtained, or withheld the full

amount of loss to the victim or victims of the fraudulent insurance act.