Felony Offenses in the Texas Penal Code

Austin Criminal Lawyer


Federal Defense Attorney

Texas Penal Code, Section 35.02 - Insurance Fraud

Chapter 35 - Insurance Fraud

§ 35.02.  INSURANCE FRAUD.
        (a)  A person commits an offense if, with intent to defraud or deceive an insurer, the person causes to be prepared or presents to an insurer in support of a claim for payment under a health or property and casualty insurance policy a statement that the person knows contains false or misleading information concerning a matter that is material to the claim, and the matter affects a person's right to a payment or the amount of payment to which a person is entitled.
        (b)  A person commits an offense if, with intent to defraud or deceive an insurer, the person solicits, offers, pays, or receives a benefit in connection with the furnishing of health care goods or services for which a claim for payment is submitted under a health or property and casualty insurance policy.
        (c)  For purposes of Subsection (a), information concerning a matter that is material to a claim for payment under an insurance policy includes information concerning:
                (1)  whether health care goods or services were provided;
                (2)  whether health care goods or services were medically necessary under professionally accepted standards;
                (3)  the nature of the health care goods or services provided;
                (4)  the date on which health care goods or services were provided;
                (5)  the medical record of goods or services provided;
                (6)  the condition treated or diagnosis made;
                (7)  the identity and applicable license of the provider or the recipient of health care goods or services;
                (8)  whether property was damaged or lost in the manner and under the circumstances described in a statement related to a claim for insurance payment;  or
                (9)  whether any other claim for insurance payment has been communicated to any other insurer concerning property damage or loss to the same property.
        (d)  An offense under this section is:
                (1)  a Class C misdemeanor if the value of the claim is less than $20;
                (2)  a Class B misdemeanor if the value of the claim is $20 or more but less than $500;
                (3)  a Class A misdemeanor if the value of the claim is $500 or more but less than $1,500;
                (4)  a state jail felony if the value of the claim is $1,500 or more but less than $20,000;
                (5)  a felony of the third degree if the value of the claim is $20,000 or more but less than $100,000;
                (6)  a felony of the second degree if the value of the claim is $100,000 or more but less than $200,000;  or
                (7)  a felony of the first degree if:
                        (A)  the value of the claim is $200,000 or more; or
                        (B)  the value of the claim is less than $200,000 and the commission of the offense placed a person at risk of death or serious bodily injury.
        (e)  The court shall order a defendant convicted of an offense under this section to pay restitution, including court costs and attorney's fees, to an affected insurer.

NOTE: This information is NOT LEGAL ADVICE. It is provided for EDUCATIONAL USE ONLY. If you need legal advice regarding a criminal matter in the state of Texas, please contact us at (512) 478-0758 or fill out a brief case questionnaire.