PRINTER'S NO. 4140
No. 3011 Session of 1992
INTRODUCED BY KENNEY, NOVEMBER 17, 1992
REFERRED TO COMMITTEE ON JUDICIARY, NOVEMBER 17, 1992
AN ACT
1 Amending Title 18 (Crimes and Offenses) of the Pennsylvania
2 Consolidated Statutes, further providing for insurance fraud.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Section 4117(b) and (j) of Title 18 of the
6 Pennsylvania Consolidated Statutes are amended to read:
7 § 4117. Insurance fraud.
8 * * *
9 (b) Additional offenses defined.--
10 (1) A lawyer may not compensate or give anything of
11 value to a nonlawyer to recommend or secure employment by a
12 client or as a reward for having made a recommendation
13 resulting in employment by a client; except that the lawyer
14 may pay:
15 (i) the reasonable cost of advertising or written
16 communication as permitted by the rules of professional
17 conduct; or
1 (ii) the usual charges of a not-for-profit lawyer
2 referral service or other legal service organization.
3 Upon a conviction of an offense provided for by this
4 paragraph, the prosecutor shall certify such conviction to
5 the disciplinary board of the Supreme Court for appropriate
6 action. Such action may include a suspension or disbarment.
7 (2) With respect to an insurance benefit or claim, a
8 health care provider may not compensate or give anything of
9 value to a person to recommend or secure the provider's
10 service to or employment by a patient or as a reward for
11 having made a recommendation resulting in the provider's
12 service to or employment by a patient; except that the
13 provider may pay the reasonable cost of advertising or
14 written communication as permitted by rules of professional
15 conduct. Upon a conviction of an offense provided for by this
16 paragraph, the prosecutor shall certify such conviction to
17 the appropriate licensing board in the Department of State
18 which shall suspend or revoke the health care provider's
19 license.
20 [(3) A lawyer or health care provider may not compensate
21 or give anything of value to a person for providing names,
22 addresses, telephone numbers or other identifying information
23 of individuals seeking or receiving medical or rehabilitative
24 care for accident, sickness or disease, except to the extent
25 a referral and receipt of compensation is permitted under
26 applicable professional rules of conduct. A person may not
27 knowingly transmit such referral information to a lawyer or
28 health care professional for the purpose of receiving
29 compensation or anything of value. Attempts to circumvent
30 this paragraph through use of any other person, including,
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1 but not limited to, employees, agents or servants, shall also
2 be prohibited.]
3 (3) A person may not receive compensation, a reward or
4 anything of value in return for providing names, addresses,
5 telephone numbers or other identifying information of victims
6 involved in motor vehicle accidents to a lawyer, health care
7 provider or repair service which results in employment of a
8 lawyer, health care provider or repair service by the victims
9 for purposes of a motor vehicle insurance claim or suit.
10 Attempts to circumvent this paragraph through use of any
11 other person, including, but not limited to, employees,
12 agents or servants, shall also be prohibited. This provision
13 shall not prohibit a lawyer, health care provider or repair
14 service from making a referral and receiving compensation as
15 is permitted under applicable professional rules of conduct.
16 * * *
17 (j) Definitions.--As used in this section, the following
18 words and phrases shall have the meanings given to them in this
19 subsection:
20 "Insurance claim." A claim for payment or other benefit
21 pursuant to an insurance policy or agreement for coverage of
22 health or hospital services.
23 "Insurance policy." A document setting forth the terms and
24 conditions of a contract of insurance or agreement for the
25 coverage of health or hospital services.
26 "Insurer." A company, association or exchange defined by
27 section 101 of the act of May 17, 1921 (P.L.682, No.284), known
28 as The Insurance Company Law of 1921; an unincorporated
29 association of underwriting members; a hospital plan
30 corporation; a professional health services plan corporation; a
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1 health maintenance organization; a fraternal benefit society;
2 and a self-insured health care entity under the act of October
3 15, 1975 (P.L.390, No.111), known as the Health Care Services
4 Malpractice Act.
5 "Person." An individual, corporation, partnership,
6 association, joint-stock company, trust or unincorporated
7 organization. The term includes any individual, corporation,
8 association, partnership, reciprocal exchange, interinsurer,
9 Lloyd's insurer, fraternal benefit society, beneficial
10 association and any other legal entity engaged or proposing to
11 become engaged, either directly or indirectly, in the business
12 of insurance, including agents, brokers, adjusters and health
13 care plans as defined in 40 Pa.C.S. Chs. 61 (relating to
14 hospital plan corporations), 63 (relating to professional health
15 services plan corporations), 65 (relating to fraternal benefit
16 societies) and 67 (relating to beneficial societies) and the act
17 of December 29, 1972 (P.L.1701, No.364), known as the Health
18 Maintenance Organization Act. For purposes of this section,
19 health care plans, fraternal benefit societies and beneficial
20 societies shall be deemed to be engaged in the business of
21 insurance.
22 "Repair service." A person or organization having temporary
23 possession of a motor vehicle for the purpose of servicing,
24 repairing, parking or transporting it.
25 "Statement." Any oral or written presentation or other
26 evidence of loss, injury or expense, including, but not limited
27 to, any notice, statement, proof of loss, bill of lading,
28 receipt for payment, invoice, account, estimate of property
29 damages, bill for services, diagnosis, prescription, hospital or
30 doctor records, X-ray, test result or computer-generated
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1 documents.
2 Section 2. This act shall take effect in 60 days.
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