A person who commits a fraudulent insurance act in New York may be charged with Insurance Fraud and Grand Larceny. Under New York law, a person commits a fraudulent insurance act when he or she knowingly and with intent to defraud:
- Presents, causes to be presented or prepares with the expectation that it will be presented
- A written statement or certain other evidence which either
- Contains false information regarding any material fact, or
- Conceals (with intent to mislead) any information regarding a material fact
- For the purposes of any of a wide range of insurance-related activities, including (but not limited to)
- Supporting an application for insurance coverage
- Presenting a claim under an insurance policy
- Certifying coverage or self-insurance
Such an act may relate to any type of insurance, whether covering one’s home, car, business or medical care. Government-provided health insurance is included in the definition. Thus, Medicaid fraud falls within the definition of Insurance Fraud in New York.
Degrees of Insurance Fraud in New York
The classification of the crime of Insurance Fraud and the possible penalties depend on the specifics of each case. Under the New York State Penal Law, there are five degrees of the crime of Insurance Fraud. The degree that is charged depends on the value of the insurance benefit sought or received.
Insurance Fraud in the Fifth Degree
Insurance Fraud in the Fifth Degree, Penal Law Section 176.10, is charged when a person commits a fraudulent insurance act. There is no specific value required, so this crime is typically charged when the benefit involved is valued $1,000 or less and there are no circumstances to trigger an enhanced charge.
The Fifth Degree crime is a class A misdemeanor, punishable by up to 1 year in jail. However, it may be possible to negotiate for a lesser charge or alternative sentence, especially when the defendant has little or no criminal history or prior contact with law enforcement.
Insurance Fraud in the Fourth Degree
Insurance Fraud in the Fourth Degree, Penal Law Section 176.15, is charged when a person commits a fraudulent insurance act and:
- Thereby wrongfully takes, obtains or withholds property valued at more than $1,000, or
- Attempts to wrongfully take, obtain or withhold property valued at more than $1,000
Although any insurance fraud involving property valued at more than $1,000 may result in a Fourth Degree charge, as a practical matter this crime applies to acts that involve property valued between $1,000 and $3,000. Property valued at more than $3,000 typically results a more serious charge.
Insurance Fraud in the Fourth Degree is a class E felony, carrying a possible prison sentence of 1 1/3 to 4 years. However, depending on the facts of the case, it may be possible to negotiate for a reduction to a misdemeanor charge, or even a more favorable resolution. For example, a person charged with Insurance Fraud in the Fourth Degree may be offered a plea bargain to a lesser crime or even a non-criminal offense if restitution can be made. To repeat: every case is different.
Insurance Fraud in the Third Degree
Insurance Fraud is charged in the Third Degree, Penal Law Section 176.20, when a person is accused of having committed a fraudulent insurance act and thereby wrongfully taken, obtained, withheld or attempted to take, obtain or withhold property valued at more than $3,000 but not more than $50,000.
Insurance Fraud in the Third Degree is a class D felony and may result in a sentence of 2 1/3 to 7 years in prison.
Insurance Fraud in the Second Degree
Insurance Fraud in the Second Degree, Penal Law Section 176.25, is charged when a person is alleged to have committed a fraudulent insurance act and thereby wrongfully taken, obtained, withheld (or attempted the same) property valued at more than $50,000.
The Second Degree crime is a class C felony and carries a potential sentence of 5 to 15 years in prison.
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Insurance Fraud in the First Degree
Insurance Fraud in the First DegreeInsurance Fraud in the First Degree, Penal Law Section 176.30, the most serious Insurance Fraud crime, is charged when a person is accused of having committed a fraudulent insurance act and thereby wrongfully taken, obtained, withheld or attempted to take, withhold or obtain property with a value in excess of $1 million.
The First Degree crime is a class B felony, which may result in a prison sentence of 8 1/3 to 25 years in prison.
Medicaid Fraud
Medicaid is a government-funded program that provides medical coverage to residents who cannot afford medical care. Eligibility is determined based on several factors, including family size, income, assets, certain expenses, citizenship or immigration status, age and disability. The New York State Health Department publishes an annual list for Medicaid qualification in New York.
Medicaid fraud most commonly occurs in one of two ways:
- A Medicaid applicant misrepresents income, assets or some other factor in order to receive benefits he or she or their children is not entitled to, or
- A medical provider bills the state for Medicaid services not actually provided
When an individual is suspected of Medicaid fraud, the recipient usually receives a home visit by an investigator or a letter indicating that eligibility or a claim is under investigation and requesting further information. The recipient’s next steps may determine whether charges are filed and impact the seriousness of any charges filed. Unfortunately, most recipients do not know how to protect themselves at this stage, and often compound the problem in an effort to avoid criminal charges.
If you have received a visit or a letter indicating that an investigation is underway, speak with a criminal defense attorney experienced in handling Medicaid fraud cases as soon as possible. The decisions you make now could have a significant impact on your future.
Like non-Medicaid insurance fraud, the nature of the charges related to Medicaid fraud depend on the value of the benefits benefit sought or received. In addition, because Medicaid applications are filed with the state or local government, a person accused of Medicaid fraud may be charged with the crime of Offering a False Instrument for Filing, which may be charged as either a felony or a misdemeanor.
If you’ve been charged with Medicaid Fraud alone or in combination with Offering a False Instrument for Filing, don’t delay in contacting a criminal defense attorney. Seek experienced legal representation immediately.
Insurance Fraud as Grand Larceny
A person who is charged with Insurance Fraud is often also charged with Larceny. The elements of Larceny are:
- Knowingly and intentionally
- Taking property (tangible or intangible)
- That belongs to another; and
- The taking is for an extended period of time, or permanent
There are five degrees of Larceny in New York. Petit Larceny, Penal Law Section 155.25, involves the taking of property valued at $1,000 or less. The crime is a class A misdemeanor with a maximum sentence of up to 1 year in jail. Petit Larceny is typically charged with Insurance Fraud in the Fifth Degree, since both crimes involve property worth no more than $1,000.
All four degrees of Grand Larceny are felonies, and the classifications and penalties are similar to the four degrees of Insurance Fraud.
Grand Larceny in the Fourth Degree
Grand Larceny in the Fourth Degree, Penal Law Section 155.30, is typically charged along with Insurance Fraud in the Fourth Degree, because both crimes involve property valued between $1,000 and $3,000. This class E felony carries a penalty of up to 4 years in prison.
Grand Larceny in the Third Degree
Grand Larceny in the Third Degree, Penal Law Section 155.35, a class D felony, involves the wrongful taking of property valued at more than $3,000 but not more than $50,000. The maximum penalty for the Third Degree crime is 7 years in prison.
Grand Larceny in the Second Degree
Grand Larceny in the Second Degree, Penal Law Section 155.40, frequently charged along with Insurance Fraud in the Second Degree, is charged when the property wrongfully taken is worth more than $50,000, but not more than $1 million. The maximum penalty for this class C felony is 15 years in prison.
Grand Larceny in the First Degree
Grand Larceny in the First Degree, Penal Law Section 155.45, is charged when the property taken is valued at more than $1 million. The First Degree crime is a class B felony, carrying a maximum penalty of 25 years in prison.
