New York Civil Rights And Criminal Defense Lawyers

What is insurance fraud and when does it become a felony?

On Behalf of | Sunday May 2, 2021 | Criminal Defense

New York Penal Code Section 176 deals with insurance fraud. For example, health insurance fraud is significant and a headache to the government.

However, people run afoul of all kinds of laws, sometimes inadvertently, and in terms of insurance fraud, a felony is more prevalent than a misdemeanor.

About insurance fraud

According to New York Penal Code Section 176, someone can commit a fraudulent insurance act if he or she knowingly presents to an insurer—or presents by an insurer—a written statement pertaining to a commercial or health insurance policy that contains materially false information, or that conceals information in order to mislead.

Misdemeanor versus felony

There are five classifications of general insurance fraud. Commission of a fraudulent insurance act in the fifth degree is a Class A misdemeanor. All the rest, B through E, are felonies. For example, a Class C felony involves taking or attempting to take property valued at more than $50,000. A Class B felony is the taking or attempted taking of property worth more than $1 million. Penalties for the misdemeanor conviction are up to a year in jail and a fine of up to $1,000. Anyone convicted of the Class B felony is looking at a prison sentence of up to 25 years.

Defense strategy

Someone could file a false health insurance claim. Someone else could provide misleading information about the cause of an accident. Because the situation has its complexities, an investigation into insurance fraud is usually a lengthy undertaking. The time to begin developing a defense strategy is when the suspect becomes aware that an investigation is underway.