Bill Text: PA HB422 | 2011-2012 | Regular Session | Introduced

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Bill Title: Further providing for insurance fraud, for penalties relating to antifraud plans, for reinstatement of operating privilege or vehicle registration, for reports by police and for admissibility of department records.

Spectrum: Moderate Partisan Bill (Republican 8-2)

Status: (Introduced - Dead) 2011-02-03 - Referred to TRANSPORTATION [HB422 Detail]

Download: Pennsylvania-2011-HB422-Introduced.html

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PRINTER'S NO. 388
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 422 Session of2011
INTRODUCED BY GODSHALL, MICOZZIE, CALTAGIRONE, CLYMER, DeLUCA, DENLINGER, HENNESSEY, SWANGER AND J. TAYLOR, FEBRUARY 3, 2011
REFERRED TO COMMITTEE ON TRANSPORTATION, FEBRUARY 3, 2011
AN ACT
Amending Titles 18 (Crimes and Offenses) and 75 (Vehicles) of
the Pennsylvania Consolidated Statutes, further providing for
insurance fraud, for penalties relating to antifraud plans,
for reinstatement of operating privilege or vehicle
registration, for reports by police and for admissibility of
department records.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 4117 of Title 18 of the Pennsylvania
Consolidated Statutes is amended to read:
§ 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.
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(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.
(9) Knowingly and willfully violates an emergency rule
or order of the Insurance Department pertaining to insurance
fraud or a provision of 31 Pa. Code (relating to insurance)
pertaining to insurance fraud.
(10) Organizes, plans or knowingly participates in an
intentional motor vehicle accident or a scheme to create
documentation of a motor vehicle accident that did not occur
for the purpose of making a tort claim or claim for personal
injury protection benefits.
(11) Creates, markets or presents a false or fraudulent
financial responsibility or other insurance identification
card with intent to deceive.
(12) Pays a bribe, in cash or in kind, to induce the
referral of patients from or to a service provider or health
care facility.
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(13) Solicits or receives a commission, bonus, referral
fee, kickback, rebate or bribe, in cash or in kind, or
engages in a split-fee arrangement of any sort in return for
acceptance or acknowledgment of treatment from a health care
provider or a health care facility.
(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
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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.
(5) An insurer may not waive a deductible or copay by a
service provider.
(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)
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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.
(e.1) License revocation.--In addition to any other penalty,
the Department of Transportation shall revoke for three years
the driver's license of any person convicted of violating this
section.
(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
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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
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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.
(l) Definitions.--As used in this section, the following
words and phrases shall have the meanings given to them in this
subsection:
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"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
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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.
Section 2. Sections 1815, 1960, 3751 and 6328 of Title 75
are amended to read:
§ 1815. Penalties.
Insurers that fail to file timely antifraud plans as required
by sections 1811 (relating to filing of plans) and 1813
(relating to review by commissioner) [are subject to the penalty
provisions of section 320 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921] shall be
assessed a civil penalty of $500 for each day of noncompliance,
which moneys shall be deposited into the Insurance Fraud
Prevention Trust Fund. Insurers that do not make a good faith
attempt to file an antifraud plan which complies with section
1812 (relating to content of plans) shall also be subject to the
penalty provisions of section 320 of the act of May 17, 1921
(P.L.682, No.284), known as The Insurance Company Law of 1921,
provided that no penalty may be imposed for the first filing
made by an insurer under this subchapter. Insurers that fail to
follow the antifraud plan shall be subject to a civil penalty
for each violation, not to exceed $10,000, at the discretion of
the commissioner after consideration of all relevant factors,
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including the willfulness of any violation.
§ 1960. Reinstatement of operating privilege or vehicle
registration.
[The] (a) General rule.--Except as provided in subsection
(b), the department shall charge a fee of $25 or, if section
1379 (relating to suspension of registration upon sixth unpaid
parking violation in cities of the first class) or 1786(d)
(relating to required financial responsibility) applies, a fee
of $50 to restore a person's operating privilege or the
registration of a vehicle following a suspension or revocation.
(b) Insurance fraud.--The department shall charge a fee of
$150 to restore a person's operating privilege following a
suspension or revocation for insurance fraud.
§ 3751. Reports by police.
(a) General rule.--Every police department that investigates
a vehicle accident for which a report must be made as required
in this subchapter and prepares a written report as a result of
an investigation either at the time and at the scene of the
accident or thereafter by interviewing the participants or
witnesses shall, within 15 days of the accident, forward an
initial written report of the accident to the department. If the
initial report is not complete, a supplemental report shall be
submitted at a later date.
(b) Furnishing copies of report.--
(1) [Police] Except as provided in subsection (c),
police departments shall, upon request, furnish a certified
copy of the full report of the police investigation of any
vehicle accident to any person involved in the accident, his
attorney or insurer, and to the Federal Government, branches
of the military service, Commonwealth agencies, and to
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officials of political subdivisions and to agencies of other
states and nations and their political subdivisions.
(2) Except as provided in paragraph (3), the cost of
furnishing a copy of a report under this subsection shall not
exceed $15.
(3) In a city of the first class, the cost of furnishing
a copy of a report under this subsection shall not exceed
$25.
(4) The copy of the report shall not be admissible as
evidence in any action for damages or criminal proceedings
arising out of a motor vehicle accident.
(5) Police departments may refuse to furnish the
complete copy of investigation of the vehicle accident
whenever there are criminal charges pending against any
persons involved in the vehicle accident unless the
Pennsylvania Rules of Criminal Procedure require the
production of the documents.
(c) Confidentiality.--
(1) Except as provided in paragraph (2), the following
information in a written police report or traffic citation
pertaining to a motor vehicle accident shall be confidential
for a period of 60 days from the date on which the written
report or citation was filed:
(i) the identity of a party who was involved in the
accident;
(ii) the home address and telephone number of a
party;
(iii) the employment address and telephone number of
a party; and
(iv) other personal information pertaining to a
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party.
(2) Paragraph (1) shall not apply to any of the
following:
(i) a party to the accident;
(ii) a legal representative of a party;
(iii) a licensed insurer of a party;
(iv) an insurer with whom a party has filed a claim
or otherwise applied for reimbursement in connection with
the accident;
(v) a person under contract with an insurer to
provide underwriting or claims information;
(vi) prosecutorial authorities;
(vii) radio and television stations licensed by the
Federal Communications Commission;
(viii) newspapers qualified to publish legal
notices;
(ix) free newspapers of general circulation; and
(x) victim services programs.
§ 6328. Admissibility of department records.
[The] (a) General rule.--Except as provided in subsection
(b), the department may send to any authorized user by
electronic transmission any certification of record or abstract
of records maintained by the department. Permissible uses shall
include, but not be limited to, certifications of driving
records and motor vehicle records. The department may also
certify electronically any documents certified to it
electronically. Authorized users include State and local police,
district attorneys, employees of the department and the Office
of Attorney General and other persons or entities as determined
by the department and listed by notice in the Pennsylvania
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Bulletin. In any proceeding before the courts or administrative
bodies of this Commonwealth, documents certified by the
department under this section and offered into evidence by an
authorized user shall be admissible into evidence.
(b) Confidentiality.--
(1) Except as provided in paragraph (2), the following
information in a written police report or traffic citation
pertaining to a motor vehicle accident shall be confidential
for a period of 60 days from the date on which the written
report or citation was filed:
(i) the identity of a party who was involved in the
accident;
(ii) the home address and telephone number of a
party;
(iii) the employment address and telephone number of
a party; and
(iv) other personal information pertaining to a
party.
(2) Paragraph (1) shall not apply to any of the
following:
(i) a party to the accident;
(ii) a legal representative of a party;
(iii) a licensed insurer of a party;
(iv) an insurer with whom a party has filed a claim
or otherwise applied for reimbursement in connection with
the accident;
(v) a person under contract with an insurer to
provide underwriting or claims information;
(vi) prosecutorial authorities;
(vii) radio and television stations licensed by the
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Federal Communications Commission;
(viii) newspapers qualified to publish legal
notices;
(ix) free newspapers of general circulation; and
(x) victim services programs.
Section 3. This act shall take effect in 60 days.
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