[§431:10A-131] Insurance fraud; penalties.  (a)  A person commits the offense of insurancefraud if the person acts or omits to act with intent to obtain benefits orrecovery or compensation for services provided, or provides legal assistance orcounsel with intent to obtain benefits or recovery, through the followingmeans:

(1)  Knowingly presenting, or causing or permitting tobe presented, with the intent to defraud, any false information on a claim;

(2)  Knowingly presenting, or causing or permitting tobe presented, any false claim for the payment of a loss;

(3)  Knowingly presenting, or causing or permitting tobe presented, multiple claims for the same loss or injury, including presentingmultiple claims to more than one insurer, except when these multiple claims areappropriate;

(4)  Knowingly making, or causing or permitting to bemade, any false claim for payment of a health care benefit;

(5)  Knowingly submitting, or causing or permitting tobe submitted, a claim for a health care benefit that was not used by, orprovided on behalf of, the claimant;

(6)  Knowingly presenting, or causing or permitting tobe presented, multiple claims for payment of the same health care benefitexcept when these multiple claims are appropriate;

(7)  Knowingly presenting, or causing or permitting tobe presented, for payment any undercharges for benefits on behalf of a specificclaimant unless any known overcharges for benefits under this article for thatclaimant are presented for reconciliation at the same time;

(8)  Aiding, or agreeing or attempting to aid,soliciting, or conspiring with any person who engages in an unlawful act asdefined under this section; or

(9)  Knowingly making, or causing or permitting to bemade, any false statements or claims by, or on behalf of, any person or personsduring an official proceeding as defined by section 710-1000.

(b)  Violation of subsection (a) is a criminaloffense and shall constitute a:

(1)  Class B felony if the value of the benefits,recovery, or compensation obtained or attempted to be obtained is more than$20,000;

(2)  Class C felony if the value of the benefits,recovery, or compensation obtained or attempted to be obtained is more than$300; or

(3)  Misdemeanor if the value of the benefits,recovery, or compensation obtained or attempted to be obtained is $300 or less.

(c)  Where the ability to make restitution canbe demonstrated, any person convicted under this section shall be ordered by acourt to make restitution to an insurer or any other person for any financialloss sustained by the insurer or other person caused by the act or acts forwhich the person was convicted.

(d)  A person, if acting without malice, shallnot be subject to civil liability for providing information, including filing areport, furnishing oral or written evidence, providing documents, or givingtestimony concerning suspected, anticipated, or completed public or privateinsurance fraud to a court, the commissioner, the insurance fraudinvestigations unit, the National Association of Insurance Commissioners, anyfederal, state, or county law enforcement or regulatory agency, or anotherinsurer if the information is provided only for the purpose of preventing,investigating, or prosecuting insurance fraud, except if the person commits perjury.

(e)  This section shall not supersede any otherlaw relating to theft, fraud, or deception.  Insurance fraud may be prosecutedunder this section, or any other applicable section, and may be enjoined by acourt of competent jurisdiction.

(f)  An insurer shall have a civil cause ofaction to recover payments or benefits from any person who has intentionallyobtained payments or benefits in violation of this section; provided that norecovery shall be allowed if the person has made restitution under subsection(c). [L 2003, c 125, §2]