March 24, 2011, Introduced by Senators SMITH and HUNE and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending sections 4501 and 4503 (MCL 500.4501 and 500.4503), as
added by 1995 PA 276.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 4501. As used in this chapter:
(a) "Authorized agency" means the department of state police;
a city, village, or township police department; a county sheriff's
department; a United States criminal investigative department or
agency; the prosecuting authority of a city, village, township,
county,
or state or of the United States; the insurance bureau
office of financial and insurance regulation; or the department of
state.
(b) "Financial loss" includes, but is not limited to, loss of
earnings, out-of-pocket and other expenses, repair and replacement
costs, investigative costs, and claims payments.
(c) "Insurance policy" or "policy" means an insurance policy,
health maintenance organization contract, nonprofit dental care
corporation certificate, or health care corporation certificate.
(d) "Insurer" means a property-casualty insurer, life insurer,
third party administrator, self-funded plan, health insurer, health
maintenance organization, nonprofit dental care corporation, health
care corporation, reinsurer, or any other entity regulated by the
insurance laws of this state and providing any form of insurance.
(e) "Organization" means an organization or internal
department of an insurer established to detect and prevent
insurance fraud.
(f) "Person" includes an individual, insurer, company,
association, organization, Lloyds, society, reciprocal or inter-
insurance exchange, partnership, syndicate, business trust,
corporation, and any other legal entity.
(g) "Practitioner" means a licensee of this state authorized
to practice medicine and surgery, psychology, chiropractic, or law,
or any other licensee of the state whose services are compensated,
directly or indirectly, by insurance proceeds, or a licensee
similarly licensed in other states and nations, or the practitioner
of any nonmedical treatment rendered in accordance with a
recognized religious method of healing.
(h) "Runner", "capper", or "steerer" means a person who
receives a pecuniary benefit from a practitioner, whether directly
or indirectly, for procuring or attempting to procure a client,
patient, or customer at the direction or request of, or in
cooperation with, a practitioner whose intent is to obtain benefits
under a contract of insurance or to assert a claim against an
insured or an insurer for providing services to the client,
patient, or customer. Runner, capper, or steerer does not include a
practitioner who procures clients, patients, or customers through
the use of public media.
(i) (h)
"Statement" includes, but is not limited to, any
notice statement, proof of loss, bill of lading, receipt for
payment, invoice, account, estimate of property damages, bill for
services, claim form, diagnosis, prescription, hospital or doctor
record, X-rays, test result, or other evidence of loss, injury, or
expense.
Sec. 4503. A fraudulent insurance act includes, but is not
limited to, acts or omissions committed by any person who
knowingly, and with an intent to injure, defraud, or deceive:
(a) Presents, causes to be presented, or prepares with
knowledge or belief that it will be presented to or by an insurer
or any agent of an insurer, or any agent of an insurer, reinsurer,
or broker any oral or written statement knowing that the statement
contains any false information concerning any fact material to an
application for the issuance of an insurance policy.
(b) Prepares or assists, abets, solicits, or conspires with
another to prepare or make an oral or written statement that is
intended to be presented to or by any insurer in connection with,
or in support of, any application for the issuance of an insurance
policy, knowing that the statement contains any false information
concerning any fact or thing material to the application.
(c) Presents or causes to be presented to or by any insurer,
any oral or written statement including computer-generated
information as part of, or in support of, a claim for payment or
other benefit pursuant to an insurance policy, knowing that the
statement contains false information concerning any fact or thing
material to the claim.
(d) Assists, abets, solicits, or conspires with another to
prepare or make any oral or written statement including computer-
generated documents that is intended to be presented to or by any
insurer in connection with, or in support of, any claim for payment
or other benefit pursuant to an insurance policy, knowing that the
statement contains any false information concerning any fact or
thing material to the claim.
(e) Solicits or accepts new or renewal insurance risks by or
for an insolvent insurer.
(f) Removes or attempts to remove the assets or records of
assets, transactions, and affairs, or a material part of the assets
or records, from the home office or other place of business of the
insurer or from the place of safekeeping of the insurer, or who
conceals or attempts to conceal the assets or record of assets,
transactions, and affairs, or a material part of the assets or
records, from the commissioner.
(g) Diverts, attempts to divert, or conspires to divert funds
of an insurer or of other persons in connection with any of the
following:
(i) The transaction of insurance or reinsurance.
(ii) The conduct of business activities by an insurer.
(iii) The formation, acquisition, or dissolution of an insurer.
(h) Employs, uses, or acts as a runner, capper, or steerer
with the intent to falsely or fraudulently obtain benefits under a
contract of insurance or to falsely or fraudulently assert a claim
against an insured or an insurer for providing services to the
client, patient, or customer.
(i) (h)
Knowingly and willfully assists, conspires with, or
urges any person to fraudulently violate this act, or any person
who due to that assistance, conspiracy, or urging knowingly and
willfully benefits from the proceeds derived from the fraud.