|Assembly Actions - Lowercase
Senate Actions - UPPERCASE
|Jul 20, 2011||signed chap.211|
|Jul 08, 2011||delivered to governor|
|Jun 20, 2011||returned to senate|
ordered to third reading rules cal.507
substituted for a8365
|Jun 15, 2011||referred to insurance|
delivered to assembly
|Jun 13, 2011||advanced to third reading|
|Jun 07, 2011||2nd report cal.|
|Jun 06, 2011||1st report cal.1026|
|Jun 02, 2011||referred to insurance|
senate Bill S5562Signed By Governor
Amends the definition of insurance fraud
Archive: Last Bill Status - Signed by Governor
- In Committee
- On Floor Calendar
- Passed Senate
- Passed Assembly
- Delivered to Governor
- Signed by Governor
view actions (13)
Jun 15, 2011 - floor VoteS5562620floor62Aye0Nay0Absent0Excused0Abstained
show floor vote details
Floor Vote: Jun 15, 2011aye (62)
Jun 6, 2011 - Insurance committee VoteS5562150committee15Aye0Nay2Aye with Reservations1Absent0Excused0Abstained
- show floor vote details
S5562 - Bill Details
- See Assembly Version of this Bill:
- Law Section:
- Insurance Law
- Laws Affected:
- Amd §403, Ins L; amd §176.05, Pen L
S5562 - Bill Texts
Amends the definition of insurance fraud.
view sponsor memo
TITLE OF BILL:
to amend the insurance law and the penal law, in relation to the
definition of insurance fraud
PURPOSE OF BILL:
The purpose of this bill is to include the activities that currently
constitute a "fraudulent health care insurance act" within the
definition of "fraudulent insurance act."
SUMMARY OF PROVISIONS:
Section 1 of the bill amends Insurance Law § 403(a) to make a
technical amendment by deleting "an" in the phrase "an insurance
Section 2 of the bill amends Penal Law § 176.05 to include the
activities that currently constitute a "fraudulent health care
insurance act" within the definition of "fraudulent insurance act. "
Section 3 states that this bill takes effect immediately.
Currently, Insurance Law § 403 states that it is a violation of the
Insurance Law for any individual, firm, association, or corporation
subject to the Insurance Law to commit a fraudulent insurance act,
and for the purposes of Article 4 of the Insurance Law, defines a
"fraudulent insurance act" as "an insurance fraud as defined in
section 176.05 of the penal law."
Penal Law § 176.05 is titled "Insurance fraud; defined," and sets
forth when a "fraudulent insurance act" is committed and when a
"fraudulent health care insurance act" is committed.
PRIOR LEGISLATIVE HISTORY:
This is a new bill.
STATEMENT IN SUPPORT:
In 1998, the Legislature amended a number of state laws to expand
health coverage for children through the Child Health Plus program
and Medicaid and concomitantly amended the
Penal Law to strengthen New York's ability to deter Medicaid fraud and
abuse. As part of these amendments, the Legislature added a new
subdivision to Penal Law § 176.05, which defines a "fraudulent health
care insurance act." However, the Legislature failed to amend Penal
Law §§ 176.10 through 176.30, which prescribe penalties for five
different degrees of insurance fraud and permit penalties only for a
person who commits a "fraudulent insurance act."
In 2003, a chief operating officer and executive vice president of a
managed health care provider was indicted on charges that included
two counts of insurance fraud in the first degree.
The indictment charged that the defendant committed fraudulent
insurance acts in 2003 when he submitted marketing plans to Medicaid
that he knew contained materially false information. The State
asserted that marketing plans allegedly submitted by the defendant
were fraudulent health care insurance acts, which are a species of
fraudulent insurance acts. The defendant moved to dismiss the
insurance fraud counts, asserting that he did not commit a
"fraudulent insurance act" as defined in the Penal Law. The New York
Supreme Court granted defendant's motion and the Appellate Division
and Court of Appeals affirmed. The New York State Court of Appeals
held in People v. Boothe, 16 N.Y.3d 195 (2011), that "a 'fraudulent
health care insurance act' is not included within the definition of
'fraudulent insurance act'" and that "the Legislature plainly failed
to criminalize the conduct at issue." The Court of Appeals further
stated that "if this deficiency is to be corrected, it must be done
through legislative action."
The Legislature's failure to criminalize activities that currently
constitute a "fraudulent health care insurance act" was not
intentional, and as a result, this deficiency in the law should be
remedied so that the Legislature may achieve its original goal of
strengthening New York's ability to deter Medicaid fraud and abuse.
Thus, this bill fixes the foregoing deficiency by amending Penal Law
§ 176.05 to include the activities that currently constitute a
"fraudulent health care insurance act" within the definition of
"fraudulent insurance act."
There are no budget implications from this bill.
This bill takes effect immediately.
view full text
S T A T E O F N E W Y O R K ________________________________________________________________________ 5562 2011-2012 Regular Sessions I N S E N A T E June 2, 2011 ___________ Introduced by Sen. SEWARD -- (at request of the New York State Insurance Department) -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the penal law, in relation to the definition of insurance fraud THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subsection (a) of section 403 of the insurance law is amended to read as follows: (a) In this article, "fraudulent insurance act" means [an] insurance fraud as defined in section 176.05 of the penal law; and the terms "personal insurance" and "commercial insurance" shall have the same meaning ascribed to them by section 176.00 of such law. S 2. Section 176.05 of the penal law, as amended by chapter 635 of the laws of 1996, subdivision 1 as designated and subdivision 2 as added by chapter 2 of the laws of 1998, is amended to read as follows: S 176.05 Insurance fraud; defined. [1.] A fraudulent insurance act is committed by any person who, know- ingly 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 [which] THAT he OR SHE knows to: [(i)] (A) contain materially false information concerning any fact material thereto; or EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10648-02-1 S. 5562 2 [(ii)] (B) conceal, for the purpose of misleading, information concerning any fact material thereto[.]; OR 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] 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 [(a)] (I) 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 thou- sand three hundred twenty-two of the insurance law or any other applica- tion for a health insurance policy or contract approved by the super- intendent of insurance in the individual or direct payment market; [and (b)] OR (II) any application for a certificate evidencing coverage under a self-insured plan or under a group contract approved by the super- intendent of insurance. S 3. This act shall take effect immediately.
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