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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| HOUSE BILL |
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| INTRODUCED BY GODSHALL, MICOZZIE, CALTAGIRONE, CLYMER, DeLUCA, DENLINGER, HENNESSEY, SWANGER AND J. TAYLOR, FEBRUARY 3, 2011 |
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| REFERRED TO COMMITTEE ON TRANSPORTATION, FEBRUARY 3, 2011 |
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| AN ACT |
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1 | Amending Titles 18 (Crimes and Offenses) and 75 (Vehicles) of |
2 | the Pennsylvania Consolidated Statutes, further providing for |
3 | insurance fraud, for penalties relating to antifraud plans, |
4 | for reinstatement of operating privilege or vehicle |
5 | registration, for reports by police and for admissibility of |
6 | department records. |
7 | The General Assembly of the Commonwealth of Pennsylvania |
8 | hereby enacts as follows: |
9 | Section 1. Section 4117 of Title 18 of the Pennsylvania |
10 | Consolidated Statutes is amended to read: |
11 | § 4117. Insurance fraud. |
12 | (a) Offense defined.--A person commits an offense if the |
13 | person does any of the following: |
14 | (1) Knowingly and with the intent to defraud a State or |
15 | local government agency files, presents or causes to be filed |
16 | with or presented to the government agency a document that |
17 | contains false, incomplete or misleading information |
18 | concerning any fact or thing material to the agency's |
19 | determination in approving or disapproving a motor vehicle |
20 | insurance rate filing, a motor vehicle insurance transaction |
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1 | or other motor vehicle insurance action which is required or |
2 | filed in response to an agency's request. |
3 | (2) Knowingly and with the intent to defraud any insurer |
4 | or self-insured, presents or causes to be presented to any |
5 | insurer or self-insured any statement forming a part of, or |
6 | in support of, a claim that contains any false, incomplete or |
7 | misleading information concerning any fact or thing material |
8 | to the claim. |
9 | (3) Knowingly and with the intent to defraud any insurer |
10 | or self-insured, assists, abets, solicits or conspires with |
11 | another to prepare or make any statement that is intended to |
12 | be presented to any insurer or self-insured in connection |
13 | with, or in support of, a claim that contains any false, |
14 | incomplete or misleading information concerning any fact or |
15 | thing material to the claim, including information which |
16 | documents or supports an amount claimed in excess of the |
17 | actual loss sustained by the claimant. |
18 | (4) Engages in unlicensed agent, broker or unauthorized |
19 | insurer activity as defined by the act of May 17, 1921 |
20 | (P.L.789, No.285), known as The Insurance Department Act of |
21 | one thousand nine hundred and twenty-one, knowingly and with |
22 | the intent to defraud an insurer, a self-insured or the |
23 | public. |
24 | (5) Knowingly benefits, directly or indirectly, from the |
25 | proceeds derived from a violation of this section due to the |
26 | assistance, conspiracy or urging of any person. |
27 | (6) Is the owner, administrator or employee of any |
28 | health care facility and knowingly allows the use of such |
29 | facility by any person in furtherance of a scheme or |
30 | conspiracy to violate any of the provisions of this section. |
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1 | (7) Borrows or uses another person's financial |
2 | responsibility or other insurance identification card or |
3 | permits his financial responsibility or other insurance |
4 | identification card to be used by another, knowingly and with |
5 | intent to present a fraudulent claim to an insurer. |
6 | (8) If, for pecuniary gain for himself or another, he |
7 | directly or indirectly solicits any person to engage, employ |
8 | or retain either himself or any other person to manage, |
9 | adjust or prosecute any claim or cause of action against any |
10 | person for damages for negligence or, for pecuniary gain for |
11 | himself or another, directly or indirectly solicits other |
12 | persons to bring causes of action to recover damages for |
13 | personal injuries or death, provided, however, that this |
14 | paragraph shall not apply to any conduct otherwise permitted |
15 | by law or by rule of the Supreme Court. |
16 | (9) Knowingly and willfully violates an emergency rule |
17 | or order of the Insurance Department pertaining to insurance |
18 | fraud or a provision of 31 Pa. Code (relating to insurance) |
19 | pertaining to insurance fraud. |
20 | (10) Organizes, plans or knowingly participates in an |
21 | intentional motor vehicle accident or a scheme to create |
22 | documentation of a motor vehicle accident that did not occur |
23 | for the purpose of making a tort claim or claim for personal |
24 | injury protection benefits. |
25 | (11) Creates, markets or presents a false or fraudulent |
26 | financial responsibility or other insurance identification |
27 | card with intent to deceive. |
28 | (12) Pays a bribe, in cash or in kind, to induce the |
29 | referral of patients from or to a service provider or health |
30 | care facility. |
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1 | (13) Solicits or receives a commission, bonus, referral |
2 | fee, kickback, rebate or bribe, in cash or in kind, or |
3 | engages in a split-fee arrangement of any sort in return for |
4 | acceptance or acknowledgment of treatment from a health care |
5 | provider or a health care facility. |
6 | (b) Additional offenses defined.-- |
7 | (1) A lawyer may not compensate or give anything of |
8 | value to a nonlawyer to recommend or secure employment by a |
9 | client or as a reward for having made a recommendation |
10 | resulting in employment by a client; except that the lawyer |
11 | may pay: |
12 | (i) the reasonable cost of advertising or written |
13 | communication as permitted by the rules of professional |
14 | conduct; or |
15 | (ii) the usual charges of a not-for-profit lawyer |
16 | referral service or other legal service organization. |
17 | Upon a conviction of an offense provided for by this |
18 | paragraph, the prosecutor shall certify such conviction to |
19 | the disciplinary board of the Supreme Court for appropriate |
20 | action. Such action may include a suspension or disbarment. |
21 | (2) With respect to an insurance benefit or claim |
22 | covered by this section, a health care provider may not |
23 | compensate or give anything of value to a person to recommend |
24 | or secure the provider's service to or employment by a |
25 | patient or as a reward for having made a recommendation |
26 | resulting in the provider's service to or employment by a |
27 | patient; except that the provider may pay the reasonable cost |
28 | of advertising or written communication as permitted by rules |
29 | of professional conduct. Upon a conviction of an offense |
30 | provided for by this paragraph, the prosecutor shall certify |
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1 | such conviction to the appropriate licensing board in the |
2 | Department of State which shall suspend or revoke the health |
3 | care provider's license. |
4 | (3) A lawyer or health care provider may not compensate |
5 | or give anything of value to a person for providing names, |
6 | addresses, telephone numbers or other identifying information |
7 | of individuals seeking or receiving medical or rehabilitative |
8 | care for accident, sickness or disease, except to the extent |
9 | a referral and receipt of compensation is permitted under |
10 | applicable professional rules of conduct. A person may not |
11 | knowingly transmit such referral information to a lawyer or |
12 | health care professional for the purpose of receiving |
13 | compensation or anything of value. Attempts to circumvent |
14 | this paragraph through use of any other person, including, |
15 | but not limited to, employees, agents or servants, shall also |
16 | be prohibited. |
17 | (4) A person may not knowingly and with intent to |
18 | defraud any insurance company, self-insured or other person |
19 | file an application for insurance containing any false |
20 | information or conceal for the purpose of misleading |
21 | information concerning any fact material thereto. |
22 | (5) An insurer may not waive a deductible or copay by a |
23 | service provider. |
24 | (c) Electronic claims submission.--If a claim is made by |
25 | means of computer billing tapes or other electronic means, it |
26 | shall be a rebuttable presumption that the person knowingly made |
27 | the claim if the person has advised the insurer in writing that |
28 | claims will be submitted by use of computer billing tapes or |
29 | other electronic means. |
30 | (d) Grading.--An offense under subsection (a)(1) through (8) |
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1 | is a felony of the third degree. An offense under subsection (b) |
2 | is a misdemeanor of the first degree. |
3 | (e) Restitution.--The court may, in addition to any other |
4 | sentence authorized by law, sentence a person convicted of |
5 | violating this section to make restitution. |
6 | (e.1) License revocation.--In addition to any other penalty, |
7 | the Department of Transportation shall revoke for three years |
8 | the driver's license of any person convicted of violating this |
9 | section. |
10 | (f) Immunity.--An insurer, and any agent, servant or |
11 | employee thereof acting in the course and scope of his |
12 | employment, shall be immune from civil or criminal liability |
13 | arising from the supply or release of written or oral |
14 | information to any entity duly authorized to receive such |
15 | information by Federal or State law, or by Insurance Department |
16 | regulations. |
17 | (g) Civil action.--An insurer damaged as a result of a |
18 | violation of this section may sue therefor in any court of |
19 | competent jurisdiction to recover compensatory damages, which |
20 | may include reasonable investigation expenses, costs of suit and |
21 | attorney fees. An insurer may recover treble damages if the |
22 | court determines that the defendant has engaged in a pattern of |
23 | violating this section. |
24 | (h) Criminal action.-- |
25 | (1) The district attorneys of the several counties shall |
26 | have authority to investigate and to institute criminal |
27 | proceedings for any violation of this section. |
28 | (2) In addition to the authority conferred upon the |
29 | Attorney General by the act of October 15, 1980 (P.L.950, |
30 | No.164), known as the Commonwealth Attorneys Act, the |
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1 | Attorney General shall have the authority to investigate and |
2 | to institute criminal proceedings for any violation of this |
3 | section or any series of such violations involving more than |
4 | one county of the Commonwealth or involving any county of the |
5 | Commonwealth and another state. No person charged with a |
6 | violation of this section by the Attorney General shall have |
7 | standing to challenge the authority of the Attorney General |
8 | to investigate or prosecute the case, and, if any such |
9 | challenge is made, the challenge shall be dismissed and no |
10 | relief shall be available in the courts of the Commonwealth |
11 | to the person making the challenge. |
12 | (i) Regulatory and investigative powers additional to those |
13 | now existing.--Nothing contained in this section shall be |
14 | construed to limit the regulatory or investigative authority of |
15 | any department or agency of the Commonwealth whose functions |
16 | might relate to persons, enterprises or matters falling within |
17 | the scope of this section. |
18 | (j) Violations, penalties, etc.-- |
19 | (1) If a person is found by court of competent |
20 | jurisdiction, pursuant to a claim initiated by a prosecuting |
21 | authority, to have violated any provision of this section, |
22 | the person shall be subject to civil penalties of not more |
23 | than $5,000 for the first violation, $10,000 for the second |
24 | violation and $15,000 for each subsequent violation. The |
25 | penalty shall be paid to the prosecuting authority to be used |
26 | to defray the operating expenses of investigating and |
27 | prosecuting insurance fraud. The court may also award court |
28 | costs and reasonable attorney fees to the prosecuting |
29 | authority. |
30 | (2) Nothing in this subsection shall be construed to |
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1 | prohibit a prosecuting authority and the person accused of |
2 | violating this section from entering into a written agreement |
3 | in which that person does not admit or deny the charges but |
4 | consents to payment of the civil penalty. A consent agreement |
5 | may not be used in a subsequent civil or criminal proceeding, |
6 | but notification thereof shall be made to the licensing |
7 | authority if the person is licensed by a licensing authority |
8 | of the Commonwealth so that the licensing authority may take |
9 | appropriate administrative action. Penalties paid under this |
10 | section shall be deposited into the Insurance Fraud |
11 | Prevention Trust Fund created under the act of December 28, |
12 | 1994 (P.L.1414, No.166), known as the Insurance Fraud |
13 | Prevention Act. |
14 | (3) The imposition of any fine or other remedy under |
15 | this section shall not preclude prosecution for a violation |
16 | of the criminal laws of this Commonwealth. |
17 | (k) Insurance forms and verification of services.-- |
18 | (1) All applications for insurance and all claim forms |
19 | shall contain or have attached thereto the following notice: |
20 | Any person who knowingly and with intent to defraud |
21 | any insurance company or other person files an |
22 | application for insurance or statement of claim |
23 | containing any materially false information or |
24 | conceals for the purpose of misleading, information |
25 | concerning any fact material thereto commits a |
26 | fraudulent insurance act, which is a crime and |
27 | subjects such person to criminal and civil penalties. |
28 | (l) Definitions.--As used in this section, the following |
29 | words and phrases shall have the meanings given to them in this |
30 | subsection: |
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1 | "Insurance policy." A document setting forth the terms and |
2 | conditions of a contract of insurance or agreement for the |
3 | coverage of health or hospital services. |
4 | "Insurer." A company, association or exchange defined by |
5 | section 101 of the act of May 17, 1921 (P.L.682, No.284), known |
6 | as The Insurance Company Law of 1921; an unincorporated |
7 | association of underwriting members; a hospital plan |
8 | corporation; a professional health services plan corporation; a |
9 | health maintenance organization; a fraternal benefit society; |
10 | and a self-insured health care entity under the act of October |
11 | 15, 1975 (P.L.390, No.111), known as the Health Care Services |
12 | Malpractice Act. |
13 | "Person." An individual, corporation, partnership, |
14 | association, joint-stock company, trust or unincorporated |
15 | organization. The term includes any individual, corporation, |
16 | association, partnership, reciprocal exchange, interinsurer, |
17 | Lloyd's insurer, fraternal benefit society, beneficial |
18 | association and any other legal entity engaged or proposing to |
19 | become engaged, either directly or indirectly, in the business |
20 | of insurance, including agents, brokers, adjusters and health |
21 | care plans as defined in 40 Pa.C.S. Chs. 61 (relating to |
22 | hospital plan corporations), 63 (relating to professional health |
23 | services plan corporations), 65 (relating to fraternal benefit |
24 | societies) and 67 (relating to beneficial societies) and the act |
25 | of December 29, 1972 (P.L.1701, No.364), known as the Health |
26 | Maintenance Organization Act. For purposes of this section, |
27 | health care plans, fraternal benefit societies and beneficial |
28 | societies shall be deemed to be engaged in the business of |
29 | insurance. |
30 | "Self-insured." Any person who is self-insured for any risk |
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1 | by reason of any filing, qualification process, approval or |
2 | exception granted, certified or ordered by any department or |
3 | agency of the Commonwealth. |
4 | "Statement." Any oral or written presentation or other |
5 | evidence of loss, injury or expense, including, but not limited |
6 | to, any notice, statement, proof of loss, bill of lading, |
7 | receipt for payment, invoice, account, estimate of property |
8 | damages, bill for services, diagnosis, prescription, hospital or |
9 | doctor records, X-ray, test result or computer-generated |
10 | documents. |
11 | Section 2. Sections 1815, 1960, 3751 and 6328 of Title 75 |
12 | are amended to read: |
13 | § 1815. Penalties. |
14 | Insurers that fail to file timely antifraud plans as required |
15 | by sections 1811 (relating to filing of plans) and 1813 |
16 | (relating to review by commissioner) [are subject to the penalty |
17 | provisions of section 320 of the act of May 17, 1921 (P.L.682, |
18 | No.284), known as The Insurance Company Law of 1921] shall be |
19 | assessed a civil penalty of $500 for each day of noncompliance, |
20 | which moneys shall be deposited into the Insurance Fraud |
21 | Prevention Trust Fund. Insurers that do not make a good faith |
22 | attempt to file an antifraud plan which complies with section |
23 | 1812 (relating to content of plans) shall also be subject to the |
24 | penalty provisions of section 320 of the act of May 17, 1921 |
25 | (P.L.682, No.284), known as The Insurance Company Law of 1921, |
26 | provided that no penalty may be imposed for the first filing |
27 | made by an insurer under this subchapter. Insurers that fail to |
28 | follow the antifraud plan shall be subject to a civil penalty |
29 | for each violation, not to exceed $10,000, at the discretion of |
30 | the commissioner after consideration of all relevant factors, |
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1 | including the willfulness of any violation. |
2 | § 1960. Reinstatement of operating privilege or vehicle |
3 | registration. |
4 | [The] (a) General rule.--Except as provided in subsection |
5 | (b), the department shall charge a fee of $25 or, if section |
6 | 1379 (relating to suspension of registration upon sixth unpaid |
7 | parking violation in cities of the first class) or 1786(d) |
8 | (relating to required financial responsibility) applies, a fee |
9 | of $50 to restore a person's operating privilege or the |
10 | registration of a vehicle following a suspension or revocation. |
11 | (b) Insurance fraud.--The department shall charge a fee of |
12 | $150 to restore a person's operating privilege following a |
13 | suspension or revocation for insurance fraud. |
14 | § 3751. Reports by police. |
15 | (a) General rule.--Every police department that investigates |
16 | a vehicle accident for which a report must be made as required |
17 | in this subchapter and prepares a written report as a result of |
18 | an investigation either at the time and at the scene of the |
19 | accident or thereafter by interviewing the participants or |
20 | witnesses shall, within 15 days of the accident, forward an |
21 | initial written report of the accident to the department. If the |
22 | initial report is not complete, a supplemental report shall be |
23 | submitted at a later date. |
24 | (b) Furnishing copies of report.-- |
25 | (1) [Police] Except as provided in subsection (c), |
26 | police departments shall, upon request, furnish a certified |
27 | copy of the full report of the police investigation of any |
28 | vehicle accident to any person involved in the accident, his |
29 | attorney or insurer, and to the Federal Government, branches |
30 | of the military service, Commonwealth agencies, and to |
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1 | officials of political subdivisions and to agencies of other |
2 | states and nations and their political subdivisions. |
3 | (2) Except as provided in paragraph (3), the cost of |
4 | furnishing a copy of a report under this subsection shall not |
5 | exceed $15. |
6 | (3) In a city of the first class, the cost of furnishing |
7 | a copy of a report under this subsection shall not exceed |
8 | $25. |
9 | (4) The copy of the report shall not be admissible as |
10 | evidence in any action for damages or criminal proceedings |
11 | arising out of a motor vehicle accident. |
12 | (5) Police departments may refuse to furnish the |
13 | complete copy of investigation of the vehicle accident |
14 | whenever there are criminal charges pending against any |
15 | persons involved in the vehicle accident unless the |
16 | Pennsylvania Rules of Criminal Procedure require the |
17 | production of the documents. |
18 | (c) Confidentiality.-- |
19 | (1) Except as provided in paragraph (2), the following |
20 | information in a written police report or traffic citation |
21 | pertaining to a motor vehicle accident shall be confidential |
22 | for a period of 60 days from the date on which the written |
23 | report or citation was filed: |
24 | (i) the identity of a party who was involved in the |
25 | accident; |
26 | (ii) the home address and telephone number of a |
27 | party; |
28 | (iii) the employment address and telephone number of |
29 | a party; and |
30 | (iv) other personal information pertaining to a |
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1 | party. |
2 | (2) Paragraph (1) shall not apply to any of the |
3 | following: |
4 | (i) a party to the accident; |
5 | (ii) a legal representative of a party; |
6 | (iii) a licensed insurer of a party; |
7 | (iv) an insurer with whom a party has filed a claim |
8 | or otherwise applied for reimbursement in connection with |
9 | the accident; |
10 | (v) a person under contract with an insurer to |
11 | provide underwriting or claims information; |
12 | (vi) prosecutorial authorities; |
13 | (vii) radio and television stations licensed by the |
14 | Federal Communications Commission; |
15 | (viii) newspapers qualified to publish legal |
16 | notices; |
17 | (ix) free newspapers of general circulation; and |
18 | (x) victim services programs. |
19 | § 6328. Admissibility of department records. |
20 | [The] (a) General rule.--Except as provided in subsection |
21 | (b), the department may send to any authorized user by |
22 | electronic transmission any certification of record or abstract |
23 | of records maintained by the department. Permissible uses shall |
24 | include, but not be limited to, certifications of driving |
25 | records and motor vehicle records. The department may also |
26 | certify electronically any documents certified to it |
27 | electronically. Authorized users include State and local police, |
28 | district attorneys, employees of the department and the Office |
29 | of Attorney General and other persons or entities as determined |
30 | by the department and listed by notice in the Pennsylvania |
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1 | Bulletin. In any proceeding before the courts or administrative |
2 | bodies of this Commonwealth, documents certified by the |
3 | department under this section and offered into evidence by an |
4 | authorized user shall be admissible into evidence. |
5 | (b) Confidentiality.-- |
6 | (1) Except as provided in paragraph (2), the following |
7 | information in a written police report or traffic citation |
8 | pertaining to a motor vehicle accident shall be confidential |
9 | for a period of 60 days from the date on which the written |
10 | report or citation was filed: |
11 | (i) the identity of a party who was involved in the |
12 | accident; |
13 | (ii) the home address and telephone number of a |
14 | party; |
15 | (iii) the employment address and telephone number of |
16 | a party; and |
17 | (iv) other personal information pertaining to a |
18 | party. |
19 | (2) Paragraph (1) shall not apply to any of the |
20 | following: |
21 | (i) a party to the accident; |
22 | (ii) a legal representative of a party; |
23 | (iii) a licensed insurer of a party; |
24 | (iv) an insurer with whom a party has filed a claim |
25 | or otherwise applied for reimbursement in connection with |
26 | the accident; |
27 | (v) a person under contract with an insurer to |
28 | provide underwriting or claims information; |
29 | (vi) prosecutorial authorities; |
30 | (vii) radio and television stations licensed by the |
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1 | Federal Communications Commission; |
2 | (viii) newspapers qualified to publish legal |
3 | notices; |
4 | (ix) free newspapers of general circulation; and |
5 | (x) victim services programs. |
6 | Section 3. This act shall take effect in 60 days. |
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