.

Lancaster PA Fraud Charges

Philadelphia Fraud Defense Lawyer
Fraud Charges: If you have questions about Fraud Charges, learn more, get legal advice and the legal representation you need from experienced Pennsylvania Criminal Lawyers defending Fraud Charges, criminal arrests and criminal punishment throughout Pennsylvania including but not limited to the greater Philadelphia area, West Chester PA, Chester County, Delaware County, Lancaster County, Montgomery County, Berks County and Bucks County. Contact our legal team today by email or call us at (215) 228-0100.

Contact Us!

The Pennsylvania Criminal Defense Lawyers of Ciccarelli Law Offices are experienced in fighting for you, representing you and answering your questions regarding Fraud Charges. We are based in the greater Philadelphia area at 304 North High Street, West Chester PA 19380 and have satellite offices for your convenience. Contact us by email or at (215) 228-0100 when you need a PA Fraud Charges Lawyer.

.

.

§ 4117.  Insurance fraud.

(a)  Offense defined.–A person commits an offense if the

person does any of the following:

(1)  Knowingly and with the intent to defraud a State or

local government agency files, presents or causes to be filed

with or presented to the government agency a document that

contains false, incomplete or misleading information

concerning any fact or thing material to the agency’s

determination in approving or disapproving a motor vehicle

insurance rate filing, a motor vehicle insurance transaction

or other motor vehicle insurance action which is required or

filed in response to an agency’s request.

(2)  Knowingly and with the intent to defraud any insurer

or self-insured, presents or causes to be presented to any

insurer or self-insured any statement forming a part of, or

in support of, a claim that contains any false, incomplete or

misleading information concerning any fact or thing material

to the claim.

(3)  Knowingly and with the intent to defraud any insurer

or self-insured, assists, abets, solicits or conspires with

another to prepare or make any statement that is intended to

be presented to any insurer or self-insured in connection

with, or in support of, a claim that contains any false,

incomplete or misleading information concerning any fact or

thing material to the claim, including information which

documents or supports an amount claimed in excess of the

actual loss sustained by the claimant.

(4)  Engages in unlicensed agent, broker or unauthorized

insurer activity as defined by the act of May 17, 1921

(P.L.789, No.285), known as The Insurance Department Act of

one thousand nine hundred and twenty-one, knowingly and with

the intent to defraud an insurer, a self-insured or the

public.

(5)  Knowingly benefits, directly or indirectly, from the

proceeds derived from a violation of this section due to the

assistance, conspiracy or urging of any person.

(6)  Is the owner, administrator or employee of any

health care facility and knowingly allows the use of such

facility by any person in furtherance of a scheme or

conspiracy to violate any of the provisions of this section.

(7)  Borrows or uses another person’s financial

responsibility or other insurance identification card or

permits his financial responsibility or other insurance

identification card to be used by another, knowingly and with

intent to present a fraudulent claim to an insurer.

(8)  If, for pecuniary gain for himself or another, he

directly or indirectly solicits any person to engage, employ

or retain either himself or any other person to manage,

adjust or prosecute any claim or cause of action against any

person for damages for negligence or, for pecuniary gain for

himself or another, directly or indirectly solicits other

persons to bring causes of action to recover damages for

personal injuries or death, provided, however, that this

paragraph shall not apply to any conduct otherwise permitted

by law or by rule of the Supreme Court.

(b)  Additional offenses defined.

(1)  A lawyer may not compensate or give anything of

value to a nonlawyer to recommend or secure employment by a

client or as a reward for having made a recommendation

resulting in employment by a client; except that the lawyer

may pay:

(i)  the reasonable cost of advertising or written

communication as permitted by the rules of professional

conduct; or

(ii)  the usual charges of a not-for-profit lawyer

referral service or other legal service organization.

Upon a conviction of an offense provided for by this

paragraph, the prosecutor shall certify such conviction to

the disciplinary board of the Supreme Court for appropriate

action. Such action may include a suspension or disbarment.

(2)  With respect to an insurance benefit or claim

covered by this section, a health care provider may not

compensate or give anything of value to a person to recommend

or secure the provider’s service to or employment by a

patient or as a reward for having made a recommendation

resulting in the provider’s service to or employment by a

patient; except that the provider may pay the reasonable cost

of advertising or written communication as permitted by rules

of professional conduct. Upon a conviction of an offense

provided for by this paragraph, the prosecutor shall certify

such conviction to the appropriate licensing board in the

Department of State which shall suspend or revoke the health

care provider’s license.

(3)  A lawyer or health care provider may not compensate

or give anything of value to a person for providing names,

addresses, telephone numbers or other identifying information

of individuals seeking or receiving medical or rehabilitative

care for accident, sickness or disease, except to the extent

a referral and receipt of compensation is permitted under

applicable professional rules of conduct. A person may not

knowingly transmit such referral information to a lawyer or

health care professional for the purpose of receiving

compensation or anything of value. Attempts to circumvent

this paragraph through use of any other person, including,

but not limited to, employees, agents or servants, shall also

be prohibited.

(4)  A person may not knowingly and with intent to

defraud any insurance company, self-insured or other person

file an application for insurance containing any false

information or conceal for the purpose of misleading

information concerning any fact material thereto.

(c)  Electronic claims submission.–If a claim is made by

means of computer billing tapes or other electronic means, it

shall be a rebuttable presumption that the person knowingly made

the claim if the person has advised the insurer in writing that

claims will be submitted by use of computer billing tapes or

other electronic means.

(d)  Grading.–An offense under subsection (a)(1) through (8)

is a felony of the third degree. An offense under subsection (b)

is a misdemeanor of the first degree.

(e)  Restitution.–The court may, in addition to any other

sentence authorized by law, sentence a person convicted of

violating this section to make restitution.

(f)  Immunity.–An insurer, and any agent, servant or

employee thereof acting in the course and scope of his

employment, shall be immune from civil or criminal liability

arising from the supply or release of written or oral

information to any entity duly authorized to receive such

information by Federal or State law, or by Insurance Department

regulations.

(g)  Civil action.–An insurer damaged as a result of a

violation of this section may sue therefor in any court of

competent jurisdiction to recover compensatory damages, which

may include reasonable investigation expenses, costs of suit and

attorney fees. An insurer may recover treble damages if the

court determines that the defendant has engaged in a pattern of

violating this section.

(h)  Criminal action.

(1)  The district attorneys of the several counties shall

have authority to investigate and to institute criminal

proceedings for any violation of this section.

(2)  In addition to the authority conferred upon the

Attorney General by the act of October 15, 1980 (P.L.950,

No.164), known as the Commonwealth Attorneys Act, the

Attorney General shall have the authority to investigate and

to institute criminal proceedings for any violation of this

section or any series of such violations involving more than

one county of the Commonwealth or involving any county of the

Commonwealth and another state. No person charged with a

violation of this section by the Attorney General shall have

standing to challenge the authority of the Attorney General

to investigate or prosecute the case, and, if any such

challenge is made, the challenge shall be dismissed and no

relief shall be available in the courts of the Commonwealth

to the person making the challenge.

(i)  Regulatory and investigative powers additional to those

     now existing.–Nothing contained in this section shall be

construed to limit the regulatory or investigative authority of

any department or agency of the Commonwealth whose functions

might relate to persons, enterprises or matters falling within

the scope of this section.

(j)  Violations, penalties, etc.

(1)  If a person is found by court of competent

jurisdiction, pursuant to a claim initiated by a prosecuting

authority, to have violated any provision of this section,

the person shall be subject to civil penalties of not more

than $5,000 for the first violation, $10,000 for the second

violation and $15,000 for each subsequent violation. The

penalty shall be paid to the prosecuting authority to be used

to defray the operating expenses of investigating and

prosecuting insurance fraud. The court may also award court

costs and reasonable attorney fees to the prosecuting

authority.

(2)  Nothing in this subsection shall be construed to

prohibit a prosecuting authority and the person accused of

violating this section from entering into a written agreement

in which that person does not admit or deny the charges but

consents to payment of the civil penalty. A consent agreement

may not be used in a subsequent civil or criminal proceeding,

but notification thereof shall be made to the licensing

authority if the person is licensed by a licensing authority

of the Commonwealth so that the licensing authority may take

appropriate administrative action. Penalties paid under this

section shall be deposited into the Insurance Fraud

Prevention Trust Fund created under the act of December 28,

1994 (P.L.1414, No.166), known as the Insurance Fraud

Prevention Act.

(3)  The imposition of any fine or other remedy under

this section shall not preclude prosecution for a violation

of the criminal laws of this Commonwealth.

(k)  Insurance forms and verification of services.

(1)  All applications for insurance and all claim forms

shall contain or have attached thereto the following notice:

Any person who knowingly and with intent to defraud

any insurance company or other person files an

application for insurance or statement of claim

containing any materially false information or

conceals for the purpose of misleading, information

concerning any fact material thereto commits a

fraudulent insurance act, which is a crime and

subjects such person to criminal and civil penalties.

(2)  (Repealed).

(l)  Definitions.–As used in this section, the following

words and phrases shall have the meanings given to them in this

subsection:

“Insurance policy.”  A document setting forth the terms and

conditions of a contract of insurance or agreement for the

coverage of health or hospital services.

“Insurer.”  A company, association or exchange defined by

section 101 of the act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921; an unincorporated

association of underwriting members; a hospital plan

corporation; a professional health services plan corporation; a

health maintenance organization; a fraternal benefit society;

and a self-insured health care entity under the act of October

15, 1975 (P.L.390, No.111), known as the Health Care Services

Malpractice Act.

“Person.”  An individual, corporation, partnership,

association, joint-stock company, trust or unincorporated

organization. The term includes any individual, corporation,

association, partnership, reciprocal exchange, interinsurer,

Lloyd’s insurer, fraternal benefit society, beneficial

association and any other legal entity engaged or proposing to

become engaged, either directly or indirectly, in the business

of insurance, including agents, brokers, adjusters and health

care plans as defined in 40 Pa.C.S. Chs. 61 (relating to

hospital plan corporations), 63 (relating to professional health

services plan corporations), 65 (relating to fraternal benefit

societies) and 67 (relating to beneficial societies) and the act

of December 29, 1972 (P.L.1701, No.364), known as the Health

Maintenance Organization Act. For purposes of this section,

health care plans, fraternal benefit societies and beneficial

societies shall be deemed to be engaged in the business of

insurance.

“Self-insured.”  Any person who is self-insured for any risk

by reason of any filing, qualification process, approval or

exception granted, certified or ordered by any department or

agency of the Commonwealth.

“Statement.”  Any oral or written presentation or other

evidence of loss, injury or expense, including, but not limited

to, any notice, statement, proof of loss, bill of lading,

receipt for payment, invoice, account, estimate of property

damages, bill for services, diagnosis, prescription, hospital or

doctor records, X-ray, test result or computer-generated

documents.

.

OUR PRACTICE AREAS

Drugs and Narcotics

You may face jail time if the drug crime was committed within 1,000 feet of a church or school.

DUI and DWI

There is nothing minor about a DUI charge in Pennsylvania. It carries consequences beyond jail time

Sex Crimes

At Ciccarelli Law Offices, we recognize the damage done by sex crime allegations.

Violent Crimes

Experience is vital, if not mandatory, when you hire an attorney to handle accusations of a violent crime.

White Collar Crimes

Ciccarelli Lawyers fights for clients charged with theft and white collar crimes alike.

Driving Offenses

You need your driver’s license to get to work, take your children to school and run household errands.

Domestic Violence

If the police show up to your house during a domestic violence call, someone leaves with them.

And More

We handle mostly all crime related cases needing an experienced legal defense.

“Ciccarelli Law Offices was extremely helpful in guiding me through this experience.”

All the attorneys made me feel very comfortable about the court experience, and their fees were not unreasonable in any way. I will definitely come back to Ciccarelli Law Offices for any legal matters in the future.

` `