2006 New York Code - Insurance Fraud; Defined.

 
  § 176.05 Insurance fraud; defined.
    1.  A  fraudulent  insurance  act  is  committed  by  any  person who,
  knowingly and with intent to defraud presents, causes to  be  presented,
  or prepares with knowledge  or belief that it will be presented to or by
  an  insurer,  self  insurer,  or  purported  insurer,  or purported self
  insurer, or any agent thereof, any written statement as part of,  or  in
  support  of,  an  application  for  the  issuance of, or the rating of a
  commercial  insurance  policy,  or  certificate  or  evidence  of   self
  insurance  for  commercial  insurance or commercial self insurance, or a
  claim for payment or other benefit pursuant to an  insurance  policy  or
  self  insurance  program  for  commercial or personal insurance which he
  knows to: (i) contain materially false information concerning  any  fact
  material  thereto;  or  (ii)  conceal,  for  the  purpose of misleading,
  information concerning any fact material thereto.
    2. A fraudulent health care insurance act is committed by  any  person
  who,  knowingly  and  with  intent  to  defraud,  presents, causes to be
  presented, or  prepares  with  knowledge  or  belief  that  it  will  be
  presented to, or by, an insurer or purported insurer or self-insurer, or
  any  agent  thereof, any written statement or other physical evidence as
  part of, or in support of, an application for the issuance of  a  health
  insurance  policy,  or  a policy or contract or other authorization that
  provides or allows coverage for, membership or enrollment in,  or  other
  services  of  a  public  or private health plan, or a claim for payment,
  services or other benefit pursuant to such  policy,  contract  or  plan,
  which he knows to:
    (a)  contain materially false information concerning any material fact
  thereto; or
    (b) conceal, for the purpose of misleading, information concerning any
  fact material thereto. Such policy or contract or plan or  authorization
  shall include, but not be limited to, those issued or operating pursuant
  to  any  public or governmentally-sponsored or supported plan for health
  care coverage or services or  those  otherwise  issued  or  operated  by
  entities  authorized  pursuant to the public health law. For purposes of
  this subdivision an "application for the issuance of a health  insurance
  policy"  shall  not  include  (a) any application for a health insurance
  policy or contract approved by the superintendent of insurance  pursuant
  to  the  provisions of sections three thousand two hundred sixteen, four
  thousand three hundred four, four thousand three hundred  twenty-one  or
  four thousand three hundred twenty-two of the insurance law or any other
  application  for  a  health insurance policy or contract approved by the
  superintendent of insurance in the individual or direct payment  market;
  and  (b)  any  application for a certificate evidencing coverage under a
  self-insured  plan  or  under  a  group   contract   approved   by   the
  superintendent of insurance.