[§431:2-403] Insurance fraud. (a) A person commits the offense of insurance fraud if the person:
(1) Intentionally or knowingly misrepresents or conceals material facts, opinions, intention, or law to obtain or attempt to obtain coverage, benefits, recovery, or compensation:
(A) When presenting, or causing or permitting to be presented, an application, whether written, typed, or transmitted through electronic media, for the issuance or renewal of an insurance policy or reinsurance contract;
(B) When presenting, or causing or permitting to be presented, false information on a claim for payment;
(C) When presenting, or causing or permitting to be presented, a claim for the payment of a loss;
(D) When presenting, or causing or permitting to be presented, multiple claims for the same loss or injury, including knowingly presenting such multiple and duplicative claims to more than one insurer;
(E) When presenting, or causing or permitting to be presented, any claim for payment of a health care benefit;
(F) When presenting, or causing or permitting to be presented, a claim for a health care benefit that was not used by, or provided on behalf of, the claimant;
(G) When presenting, or causing or permitting to be presented, improper multiple and duplicative claims for payment of the same health care benefit;
(H) When presenting, or causing or permitting to be presented, for payment any undercharges for benefits on behalf of a specific claimant unless any known overcharges for benefits under this article for that claimant are presented for reconciliation at the same time;
(I) When fabricating, altering, concealing, making an entry in, or destroying a document whether typed, written, or through an audio or video tape or electronic media;
(J) When presenting, or causing or permitting to be presented, to a person, insurer, or other licensee false, incomplete, or misleading information to obtain coverage or payment otherwise available under an insurance policy;
(K) When presenting, or causing or permitting to be presented, to a person or producer, information about a person's status as a licensee that induces a person or insurer to purchase an insurance policy or reinsurance contract; and
(L) When making, or causing or permitting to be made, any statement, either typed, written, or through audio or video tape or electronic media, or claims by the person or on behalf of a person with regard to obtaining legal recovery or benefits;
(2) Intentionally or knowingly aids, agrees, or attempts to aid, solicit, or conspire with any person who engages in an unlawful act as defined under this section; or
(3) Intentionally or knowingly makes, causes, or permits to be presented, any false statements or claims by any person or on behalf of any person during an official proceeding as defined by section 710-1000.
(b) Violation of subsection (a) is a criminal offense and shall constitute:
(1) A class B felony if the value of the benefits, recovery, or compensation obtained or attempted to be obtained is more than $20,000;
(2) A class C felony if the value of the benefits, recovery, or compensation obtained or attempted to be obtained is more than $300; or
(3) A misdemeanor if the value of the benefits, recovery, or compensation obtained or attempted to be obtained is $300 or less.
(c) This section shall not supersede any other law relating to theft, fraud, or deception. Insurance fraud may be prosecuted under this part, or any other applicable statute or common law, and all such remedies shall be cumulative. [L 2009, c 149, pt of §2]
Section: Previous 431-2-305 431-2-306 431-2-307 431-2-307.5 431-2-308 431-2-401 431-2-402 431-2-403 431-2-404 431-2-405 431-2-406 431-2-407 431-2-408 431-2-409 431-2-410 NextLast modified: October 27, 2016