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Insurance Fraud

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.

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