New York Insurance fraud is a broad term that includes numerous acts the law considers illegal. And yes, all of them are related to stealing from insurance companies. Insurance fraud in New York and virtually all other states are probably the most commonly prosecuted white collar crime.
Recent legislation and general policy of insurance fraud crackdown changes released state and local prosecutors and investigators after unexpecting (and expecting) insurance fraudsters. Insurance fraud prosecutions and indictments statewide have dramatically increased as the result. Unfortunately, many individuals accused of insurance fraud in New York are not even aware what it is they’ve done wrong. This article provides some basic information on what is New York insurance fraud.
New York insurance fraud lawyers are busy defending people against charges of health insurance fraud, auto insurance fraud, Medicaid fraud, unemployment benefits fraud, and welfare fraud. So, what is fraud? In short, under section 176.05 of the New York Penal Code, a fraudulent insurance act is intentional and deliberate submission of an insurance application to an insurance carrier or its agents. Fraudulent means either submitting false information or concealing, for the purpose of misleading, information concerning any material fact.
There are several degrees of New York Insurance fraud. A default New York insurance fraud charge is insurance fraud in the fifth degree, a class A misdemeanor. All subsequent degrees vary as following. If in addition to the generic act of insurance fraud the person wrongfully obtains property with a value of more than ,000, it is insurance fraud in the fourth degree is a class E felony. ,000 makes it insurance fraud in the third degree is a class D felony. ,000 means insurance fraud in the second degree is a class C felony, and, finally, stealing a million dollars will make one guilty of insurance fraud in the first degree, a class B felony.
A person who commits a fraudulent insurance act, and has been previously convicted within the preceding five years of any insurance fraud crime is automatically guilty of aggravated insurance fraud in the fourth degree is a class D felony.
Insurance fraud investigation normally takes time. Police rarely arrest people suspected of insurance fraud without warrant and some investigation. When an investigation is underway, the suspect will receive a letter or a telephone call from an investigator. The person’s actions at that point may determine the outcome of the case. The worst that can be done is voluntary submission of any information to the investigators who are trained in gathering incriminating information and building cases against suspects. The better way is to talk to an attorney immediately and protect your rights. Investigators will not question persons who wish to consult an attorney. An experienced New York insurance fraud lawyer, if timely retained, may mitigate future damages and in some cases even convince prosecutors not to proceed with the case.
PBU-SIFE participated in “Making a Dent in Insurance Fraud,” an ethics case study competition hosted by Centenary College SIFE. Our team learned about the evils of insurance fraud and took action to expose them. Through our teaching, we hope to empower others with the knowledge necessary to avoid being a victim of this crime. PBU-SIFE was awarded the first place award for their presentation.
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Question by michelle j: insurance fraud?
Is it insurance fraud to list someone as your husband on your health insurance when you have been together for 9 yrs and have 3 children together? we just never got married and i do pay for it out of my check bi-weekly…
Best answer:
Answer by Cat
Yes.
But you can just go down to the court house, and get married on your lunch hour, to fix that.
Give your answer to this question below!
New Leaders: Ralph Hudgens wants to fight fraud, red tape as insurance commissioner
Newly elected state Insurance Commissioner Ralph Hudgens plans to aggressively root out fraud when he takes office next week.
Read more on Athens Banner-Herald
the biiggest fraudsters are the insurrers, why do they increase the costs of our insurance by spending huge amounts of OUR money on advertising on every possible media channel. Why do they have to use our money to pay for the advertising while third party insurance is compulsory and is not an optional service. Third party insurance should be banned because it adds up on our bills and only fully comprehensive should be allowed. It’s just plain common sense.
These people are my heroes!!! Insurance is a fraud and racket exempt from Anti-Monopoly legislation . The collude with crooked oversight panels to set artificially high rates….and then talk about $200 claims….
my dad runs a childrens hospital and he has me on medicaire. he even brought me to his hospital and charged medicaide. it goes deeper…
anyone want a scape goat? steven j allen ceo osu children’s hospital
nice vid
It upset us so much. It scared us to death.
What if we had stayed there with the crazy woman who acted like she would attack us? What a hassle would that have been for us! When we had done nothing. Now I think I understand and I despise scammers.
I often wondered why people over react and yell out damage when there is none!
My mother and I were at retailers parking lot. We had parked our buggy, when a lady in front of us starts yelling that we had damaged her car. My mother said, I didn’t touch your car! The other lady went on a tirade, so we left. The police pulled us over on the way home and asked us if we had just left the business and hadn’t we been in accident? We said, no and he checked our car out thoroughly,like we were lying!
Too boring. I was looking for something to show students but they will fall asleep during this.
Not necessarily. Firstly check to see what your health plan’s definition of “family” and “spouse” is. Having a child and living in the same house with a partner might meet the Plan’s requirements.
Secondly, your State might have particular rules that qualify you and your partner to enroll in a private health plan as a family.
Lastly, does your state recognize Common Law marriages? If so, being together for 9 years and having 3 children together probably will fit the bill. In that case, you probably have been legally married for a while.
If none of the above are true, I wouldnt call it insurance fraud but your partner might not be eligible for coverage. In that case the insurance co might not pay any claims filed on his behalf or will want it’s money back for claims already paid so tread carefully. I wouldnt pick up the phone and ask the insurance co straight out because that will tip them off. Instead, I’d approach your HR dept and ask someone there.
On a side note, it can be messy having a situation like yours if there is some sort of contingency event. Suppose something happened to you or your partner. Can you legally inherit their property? Are you eligible to receive a life insurance (hopefully you have it, since you have 3 kids) payout? Stuff like that. Whatever your personal beliefs regarding marriage are, being married affords you rights and protections (and obligations) that unmarried people do not have. Look into it.
Yes.
He’s not your husband.
He’s a long term shack up.
When the health insurance company finds out — they will come after you for anything they paid for on his behalf.
How about a trip to the court house and make it legit? People have gotten married for worse reasons!
Hi,
I think sothere is right. You’re carrying on a live-together.This type of relationship is gaining a kind of legal and social status these days.So,you should check this out from a lawyer.
If you’re not married, then yes, it’s insurance fraud. If they find out about it, they will bill YOU, the SUBSCRIBER, for full reimbursement of everything they’ve paid out on his behalf.
Why don’t you just run down to the courthouse next week and make it legal?
Yes. If your plan stipulates that a “spouse” is defined as a legally married spouse, you are committing fraud by listing your significant other on the policy.
Be forewarned that many companies are doing dependent eligibility audits to catch employees in your situation. If your employer or insurer decides to audit you, they will request a copy of a marriage certificate.
When you are not able to provide the document showing that you were married for the duration of the time that you’ve claimed him on your policy, the penalties can be stiff. For example, the insurer could revoke payment of all medical claims paid on his behalf. The doctors/hospitals who had payments taken back by the insurance company will come after you for the money. Your employer could force you to pay back any premiums they contributed on your “husband”‘s behalf. And…even worse…your employer could even fire you for ripping them off.
So, to answer your question, yes you are committing fraud. Geez…if you want all the perks of being married (such as providing insurance through your employer), you’ve been together 9 years, and have 3 kids together, then why not get married already? Or else don’t expect all the perks of being married if you’re not willing to do it.
I’d highly recommend reading the following recent article from Business Week, so that you can understand what could happen if you continue to commit this fraud:
“You’ve Got Dependents? Prove It” http://www.businessweek.com/magazine/content/07_48/b4060082.htm?chan=top+news_top+news+index_businessweek+exclusives
A similar article from the Wall Street Journal:
http://online.wsj.com/article/SB118946144721423027.html?mod=googlenews_wsj
More recent articles about auditing to make sure dependents/spouses are legit:
http://www.sunherald.com/business/v-print/story/293431.html
http://www.emaxhealth.com/72/19930.html