§ 176.05 Insurance fraud; defined.\n 1. A fraudulent insurance act is committed by any person who,\nknowingly and with intent to defraud presents, causes to be presented,\nor prepares with knowledge or belief that it will be presented to or by\nan insurer, self insurer, or purported insurer, or purported self\ninsurer, or any agent thereof:\n (a) any written statement as part of, or in support of, an application\nfor the issuance of, or the rating of a commercial insurance policy, or\ncertificate or evidence of self insurance for commercial insurance or\ncommercial self insurance, or a claim for payment or other benefit\npursuant to an insurance policy or self insurance program for commercial\nor personal insurance that such person knows to:\n (i) contain materially false information concerning any fact material\nthereto; or\n (ii) conceal, for the purpose of misleading, information concerning\nany fact material thereto; or\n (b) any written statement or other physical evidence as part of, or in\nsupport of, an application for the issuance of a health insurance\npolicy, or a policy or contract or other authorization that provides or\nallows coverage for, membership or enrollment in, or other services of a\npublic or private health plan, or a claim for payment, services or other\nbenefit pursuant to such policy, contract or plan that such person knows\nto:\n (i) contain materially false information concerning any material fact\nthereto; or\n (ii) conceal, for the purpose of misleading, information concerning\nany fact material thereto.\n Such policy or contract or plan or authorization shall include, but\nnot be limited to, those issued or operating pursuant to any public or\ngovernmentally-sponsored or supported plan for health care coverage or\nservices or those otherwise issued or operated by entities authorized\npursuant to the public health law. For purposes of this subdivision an\n"application for the issuance of a health insurance policy" shall not\ninclude (i) any application for a health insurance policy or contract\napproved by the superintendent of financial services pursuant to the\nprovisions of sections three thousand two hundred sixteen, four thousand\nthree hundred four, four thousand three hundred twenty-one or four\nthousand three hundred twenty-two of the insurance law or any other\napplication for a health insurance policy or contract approved by the\nsuperintendent of financial services in the individual or direct payment\nmarket; or (ii) any application for a certificate evidencing coverage\nunder a self-insured plan or under a group contract approved by the\nsuperintendent of financial services.\n 2. A person who hires, requests, encourages, orchestrates, or invites\nanother individual to stage a motor vehicle accident, as that term is\ndefined in section 176.75 of this article, commits a fraudulent\ninsurance act, and the person who hired, requested, encouraged,\norchestrated, or invited the other to stage a motor vehicle accident\nshall be deemed to have wrongfully taken, obtained, or withheld the full\namount of loss to the victim or victims of the fraudulent insurance act.\n
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