2012 New York Consolidated Laws
PEN - Penal
Part 3 - SPECIFIC OFFENSES
Title K - OFFENSES INVOLVING FRAUD
Article 176 - (176.00 - 176.70) INSURANCE FRAUD
176.05 - Insurance fraud; defined.

 
  § 176.05 Insurance fraud; defined.
    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:
    1. 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 that he or she knows to:
    (a) contain materially false information concerning any fact  material
  thereto; or
    (b) conceal, for the purpose of misleading, information concerning any
  fact material thereto; or
    2.  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 that he or  she  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 (i) any application for a health insurance  policy  or  contract
  approved  by  the  superintendent  of financial services 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 financial services in the individual or direct payment
  market;  or  (ii)  any application for a certificate evidencing coverage
  under a self-insured plan or under a  group  contract  approved  by  the
  superintendent of financial services.