N.Y. Laws » CHAPTER Penal / PART Specific Offenses / TITLE Offenses Involving Fraud / ARTICLE Insurance Fraud
New York Consolidated Laws

N.Y. Penal Law § 176.05 (2026)

Insurance fraud; defined

✓ current as of May 2026
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§ 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.
Notes of Decisions
Cited in 29 cases (1 in the last 5 years), 1985–2025 · leading case: People v. Alfaro, 108 A.D.2d 517 (N.Y. App. Div. 1985).
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People v. Alfaro, 108 A.D.2d 517 (N.Y. App. Div. 1985). · cites it 3× “On the other hand, insurance fraud requires a finding that the defendant “knowingly and with intent to defraud presents * * * any written statement as part of, or in support of, an application for the issuance of * * * a claim for payment or other benefit pursuant to an…”
Bienvenido Lanfranco v. Timothy Murray, Superintendent, Groveland Corr. Facility, 313 F.3d 112 (2d Cir. 2002). “See N.Y. Penal Law § 176.05 (1) (defining a fraudulent insurance act as, inter alia, presentation of a written statement to an insurer as part of a claim for payment).”
People v. Boothe, 944 N.E.2d 1137 (N.Y. 2011). · cites it 2× “As relevant here, Penal Law § 176.05 (1) provides that a person commits a “fraudulent insurance act” when he: “knowingly and with intent to defraud presents .”
People v. Abraham, 1 N.E.3d 797 (N.Y. 2013). “a claim for payment or other benefit” containing “materially false information” or concealing “information concerning” a material fact (Penal Law § 176.05 [1] [a], [b]). *146 The prosecution’s theory of the case, as charged in the indictment, was that defendant obtained…”
People v. Ferone, 136 A.D.2d 282 (N.Y. App. Div. 1988). · cites it 5× “Penal Law § 176.05, which defines insurance fraud, states: "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 or…”
Logan v. State, 48 S.W.3d 296 (Tex. App. 2001). “§ 638:20(IV) (2000) (value of the fraudulent portion of the claim); N.Y. Penal Law §§ 176.05 — 176.35 (Consol.”
Zharov v. New York State Dep't of Health, 4 A.D.3d 580 (N.Y. App. Div. 2004). “This testimony was contradicted by her criminal court plea allocution, attesting that she submitted a consultation report she prepared which embellished a patient’s injuries, and she pleaded guilty to a felony which required her to act “knowingly and with intent to defraud”…”
People v. Trump, 2025 NY Slip Op 04756 (N.Y. App. Div. 2025). · cites it 24× “Penal Law § 176.05 is applicable when among other things, a person "causes to be presented" a false written statement.”
Matter of Graham v. Coughlin, 531 N.E.2d 640 (N.Y. 1988). · cites it 2× “For this reason, I agree that petitioner's automatic termination under Public Officers Law § 30 (1) (e) was warranted [2] and, accordingly, vote to affirm.”
People v. Murray, 185 A.D.3d 1507 (N.Y. App. Div. 2020). “Contrary to defendant's specific contention, even if he did not personally complete and sign each claim form, the evidence is legally sufficient to establish that he " cause[d] to be presented" a written statement containing materially false information in support of a claim for…”
Handler v. DiNapoli, 13 N.E.3d 653 (N.Y. 2014). “Although there may be business reasons not to pursue collection of any and all co-payments, failure to collect these fees can result in civil and criminal penalties for insurance fraud (see Insurance Law § 403 [c]; Penal Law § 176.05 [2]). A provider’s failure to collect a…”
People v. Stevens, 65 A.D.3d 759 (N.Y. App. Div. 2009). “a claim for payment or other benefit pursuant to an insurance policy or self insurance program for commercial or personal insurance which he [or she] knows to: (i) contain materially false information concerning any fact material thereto; or (ii) conceal, for the purpose of…”
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