§ 22:1924 — Prohibited activities and sanctions

§1924. Prohibited activities and sanctions
A.(1)(a) Any person who, with the intent to injure, defraud, or deceive any insurance
company, or the Department of Insurance, or any insured or other party in interest, or any
third-party claimant commits any of the acts specified in Paragraph (2) or (3) of this
Subsection is guilty of a felony and shall be subjected to a term of imprisonment, with or
without hard labor, not to exceed five years, or a fine not to exceed five thousand dollars, or
both, on each count.
(b) In addition to the criminal penalties provided in Subparagraph (a) of this
Paragraph, the defendant shall make payment of restitution to the victim or victim company
of any insurance payments to the defendant that the court determines were not owed and the
costs incurred by the victim or victim company associated with the evaluation and defense
of the fraudulent claim, including but not limited to the investigative costs, attorney fees, and
court costs. However, if the amount of the benefit that is the subject of the criminal act does
not exceed one thousand dollars, the term of imprisonment shall not exceed six months, and
any fine shall not exceed one thousand dollars on each count.
(2) The following acts shall be punishable as provided in Paragraph (1) of this
Subsection:
(a) Committing any fraudulent insurance act as defined in R.S. 22:1923.
(b) Presenting or causing to be presented any written or oral statement including
computer-generated documents as part of or in support of or denial of a claim for payment
or other benefit pursuant to an insurance policy, knowing that such statement contains any
false, incomplete, or fraudulent information concerning any fact or thing material to such
claim or insurance policy.
(c) Assisting, abetting, soliciting, or conspiring with another to prepare or make any
written or oral statement that is intended to be presented to any insurance company, insured,
the Department of Insurance, or other party in interest or third-party claimant in connection
with, or in support of or denial, or any claim for payment of other benefit pursuant to an
insurance policy, knowing that such statement contains any false, incomplete, or fraudulent
information concerning any fact or thing material to such claim or insurance policy.
(3)(a) Knowingly and willfully committing health care fraud shall be punishable as
provided in Paragraph (1) of this Subsection.
(b) "Health care fraud" shall mean, in conjunction with the delivery of or payment
for health care benefits, items, or services:
(i) To execute a scheme or artifice to defraud any health care benefit program.
(ii) To obtain, by means of fraudulent claims, or false or fraudulent pretenses,
representations, or promises, any of the money or property owned by, or under the custody
or control of, any health care benefit program.
(c) For the purposes of this Paragraph, "knowingly and willfully" shall mean to
continue with a practice, after written notice to cease such practice from a health care benefit
program by certified mail, return receipt requested, except when the health care provider
reasonably believes that such practice materially complies with coding or billing standards
as issued by the American Medical Association, the United States Department of Health and
Human Services, the Centers for Medicare and Medicaid Services, or the Louisiana Medicaid
Program.
B. The criminal provisions of this Section shall be investigated, enforced, or
prosecuted only by the proper law enforcement and prosecutorial agencies.
C. In addition to the venue established by Code of Criminal Procedure Articles 611
and 614, venue shall also be appropriate in the Nineteenth Judicial District Court, parish of
East Baton Rouge.

Legislative History

Acts 1992, No. 707, §2; Acts 2001, No. 1158, §1; Acts 2008, No. 15, §1; Redesignated from R.S. 22:1243 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 632, §1; Acts 2019, No. 83, §1, eff. July 1, 2019; Acts 2024, No. 340, §1, eff. May 28, 2024.