H 4434 Session 112 (1997-1998)
H 4434 General Bill, By Fleming, Barrett, Beck, Cooper, Easterday, Edge,
Hawkins, Inabinett, B.L. Jordan, Knotts, Law, Leach, Loftis, J.D. McMaster,
Riser, Sandifer, Seithel, Stille, Tripp and Whatley
A BILL TO AMEND SECTION 38-43-240, AS AMENDED, CODE OF LAWS OF SOUTH CAROLINA,
1976, RELATING TO CERTAIN OFFENSES BY INSURANCE AGENTS, SO AS TO PROVIDE FOR A
DIFFERENT MISDEMEANOR VIOLATION AND PROVIDE A DIFFERENT PENALTY, AND ESTABLISH
FELONY VIOLATIONS AND PENALTIES; TO AMEND SECTION 38-43-245, RELATING TO
INSURANCE AGENTS AND FRAUDULENT INSURANCE APPLICATIONS, SO AS TO, AMONG OTHER
THINGS, CHANGE THE FELONY FOR CERTAIN ACTIVITY TO A "FELONY FOR A FIRST
OFFENSE" AND CHANGE THE PENALTY, AND ESTABLISH A "FELONY FOR A SECOND OR
SUBSEQUENT OFFENSE" FOR THE SAME ACTIVITY AND PROVIDE A PENALTY; TO AMEND
SECTION 38-55-170, AS AMENDED, RELATING TO CONDUCT OF INSURANCE BUSINESS AND
PRESENTING FALSE CLAIMS FOR PAYMENT, SO AS TO, AMONG OTHER THINGS, CHANGE THE
NATURE OF EXISTING FELONY OFFENSES AND CHANGE THE PENALTIES, AND PROVIDE THAT,
FOR THE PURPOSE OF DETERMINING THE DOLLAR AMOUNT OF "CLAIM OR CLAIMS" UNDER
THIS SECTION, IF A PERSON HAS MULTIPLE VIOLATIONS OF THIS SECTION AGAINST THE
SAME VICTIM, THOSE VIOLATIONS MAY BE TREATED AS AN AGGREGATE AMOUNT OR AS
INDIVIDUAL OFFENSES; TO AMEND SECTION 38-55-540, RELATING TO INSURANCE FRAUD
AND REPORTING IMMUNITY, CRIMINAL PENALTI
01/20/98 House Introduced and read first time HJ-10
01/20/98 House Referred to Committee on Judiciary HJ-10
A BILL
TO AMEND SECTION 38-43-240, AS AMENDED, CODE OF
LAWS OF SOUTH CAROLINA, 1976, RELATING TO CERTAIN
OFFENSES BY INSURANCE AGENTS, SO AS TO PROVIDE
FOR A DIFFERENT MISDEMEANOR VIOLATION AND
PROVIDE A DIFFERENT PENALTY, AND ESTABLISH
FELONY VIOLATIONS AND PENALTIES; TO AMEND
SECTION 38-43-245, RELATING TO INSURANCE AGENTS
AND FRAUDULENT INSURANCE APPLICATIONS, SO AS TO,
AMONG OTHER THINGS, CHANGE THE FELONY FOR
CERTAIN ACTIVITY TO A "FELONY FOR A FIRST OFFENSE"
AND CHANGE THE PENALTY, AND ESTABLISH A "FELONY
FOR A SECOND OR SUBSEQUENT OFFENSE" FOR THE SAME
ACTIVITY AND PROVIDE A PENALTY; TO AMEND SECTION
38-55-170, AS AMENDED, RELATING TO CONDUCT OF
INSURANCE BUSINESS AND PRESENTING FALSE CLAIMS
FOR PAYMENT, SO AS TO, AMONG OTHER THINGS,
CHANGE THE NATURE OF EXISTING FELONY OFFENSES
AND CHANGE THE PENALTIES, AND PROVIDE THAT, FOR
THE PURPOSE OF DETERMINING THE DOLLAR AMOUNT OF
"CLAIM OR CLAIMS" UNDER THIS SECTION, IF A PERSON
HAS MULTIPLE VIOLATIONS OF THIS SECTION AGAINST
THE SAME VICTIM, THOSE VIOLATIONS MAY BE TREATED
AS AN AGGREGATE AMOUNT OR AS INDIVIDUAL
OFFENSES; TO AMEND SECTION 38-55-540, RELATING TO
INSURANCE FRAUD AND REPORTING IMMUNITY,
CRIMINAL PENALTIES FOR MAKING FALSE STATEMENT
OR MISREPRESENTATION OR ASSISTING, ABETTING,
SOLICITING, OR CONSPIRING TO DO SO, AND RESTITUTION
TO VICTIMS, SO AS TO, AMONG OTHER THINGS, CHANGE
CERTAIN PENALTIES, CHANGE AN EXISTING
MISDEMEANOR TO A FELONY AND CHANGE THE
PENALTIES, CHANGE THE NATURE OF AN EXISTING
FELONY AND THE PENALTY, AND PROVIDE THAT, FOR
THE PURPOSE OF DETERMINING THE DOLLAR AMOUNT OF
THE ECONOMIC ADVANTAGE OR BENEFIT UNDER THIS
SECTION, IF A PERSON HAS MULTIPLE VIOLATIONS OF
THIS SECTION AGAINST THE SAME VICTIM, THOSE
VIOLATIONS MAY BE TREATED AS AN AGGREGATE
AMOUNT OR AS INDIVIDUAL OFFENSES; TO AMEND
SECTION 38-55-550, RELATING TO INSURANCE FRAUD AND
REPORTING IMMUNITY AND CIVIL PENALTIES, SO AS TO
CHANGE THESE PENALTIES; TO AMEND THE 1976 CODE BY
ADDING SECTION 38-55-555 SO AS TO PROVIDE THAT A
CONVICTION FOR VIOLATING ANY SECTION OF TITLE 38
MAY BE USED TO ENHANCE ANY SUBSEQUENT
CONVICTION FOR VIOLATING TITLE 38 AS A SECOND OR
SUBSEQUENT OFFENSE; AND TO AMEND SECTION
38-55-570, AS AMENDED, RELATING TO INSURANCE FRAUD
AND REPORTING IMMUNITY, NOTIFICATION OF THE
INSURANCE FRAUD DIVISION OF KNOWLEDGE OR BELIEF
OF FALSE STATEMENTS OR MISREPRESENTATIONS, AND
INFORMATION WHICH MUST BE RELEASED BY AN
INSURER, AUTHORIZED AGENCY, OR OTHERS, SO AS TO
PROVIDE THAT A PERSON, INSURER, OR AUTHORIZED
AGENCY WHO VIOLATES THE RELEASE-OF-INFORMATION
PROVISIONS OF THIS SECTION IS GUILTY OF A
MISDEMEANOR, AND PROVIDE FOR A PENALTY.
Be it enacted by the General Assembly of the State of South
Carolina:
SECTION 1. Section 38-43-240(B) of the 1976 Code, as amended
by Section 215 of Act 184 of 1993, is amended to read:
"(B) A person who violates the provisions of this section is guilty
of a: misdemeanor and, upon conviction, must be fined
in the discretion of the court or imprisoned not more than two
years.
(1) misdemeanor for a first offense if the aggregate amount
is less than one thousand dollars. Upon conviction, the person must
be imprisoned for a term not to exceed two years, or fined not more
than five thousand dollars, or both;
(2) felony for a first offense if the aggregate amount is one
thousand dollars or more but less than five thousand dollars. Upon
conviction, the person must be imprisoned for a term not to exceed
five years, or fined not more than ten thousand dollars, or both;
(3) felony for a first offense if the aggregate amount is five
thousand dollars or more, or a felony for a second or subsequent
offense regardless of the aggregate amount. Upon conviction, the
person must be imprisoned for a term not to exceed ten years and
may be fined an amount not to exceed twenty-five thousand
dollars."
SECTION 2. Section 38-43-245 of the 1976 Code is amended to
read:
"Section 38-43-245. Any A licensed insurance
agent who, with the intent to injure, defraud, or deceive any
an insurance company or applicant for insurance:
(1) presents or causes to be presented to any an
insurance company an application for insurance, knowing that the
application contains any false or misleading information or omissions
concerning any fact or thing material to the underwriting of the
insurance for which the application is submitted, or
(2) assists, abets, solicits, or conspires with another to prepare or
make an application for insurance, knowing that the application
contains any false or misleading information or omissions concerning
any fact or thing material to the underwriting of the insurance for
which the applicant application is submitted, is guilty
of a (a) felony for a first offense and, upon
conviction, must be punished by imprisonment for not more than five
years or a fine not to exceed five ten thousand
dollars, or both, or (b) a felony for a second or subsequent
offense and, upon conviction, must be punished by imprisonment for
not more than ten years and may be fined not more than twenty-five
thousand dollars."
SECTION 3. Section 38-55-170 of the 1976 Code, as last amended
by Section 121 of Act 184 of 1993, is further amended to read:
"Section 38-55-170. A person who knowingly causes to be
presented a false claim for payment to an insurer transacting business
in this State, to a health maintenance organization transacting
business in this State, or to any person, including the State of South
Carolina, providing benefits for health care in this State, whether
these benefits are administered directly or through a third person, or
who knowingly assists, solicits, or conspires with another to present
a false claim for payment as described above, is guilty of a:
(1) felony for a first offense if the amount of the claim
or claims is five thousand dollars or more, or a felony
for a second or subsequent offense regardless of the dollar amount of
the claim or claims. Upon conviction, the person must be
imprisoned not more than ten years or fined not more than
five fifty thousand dollars, or both;
(2) felony for a first offense if the amount of the claim
or claims is more than one thousand dollars but less than five
thousand dollars. Upon conviction, the person must be fined in
the discretion of the court or imprisoned not more than five years
or fined not more than twenty-five thousand dollars, or both;
(3) misdemeanor triable in magistrate's court if the amount of the
claim is one thousand dollars or less. Upon conviction, the person
must be fined or imprisoned not more than is permitted by law
without presentment or indictment by the grand jury.
For the purpose of determining the dollar amount of 'claim or
claims', if a person has multiple violations of this section against the
same victim, those violations may be treated as an aggregate amount
or as individual offenses."
SECTION 4. Section 38-55-540 of the 1976 Code, as added by
Section 31A, Part II of Act 497 of 1994, is amended to read:
"Section 38-55-540. Any person or insurer who makes a false
statement or misrepresentation, and any other person knowingly, with
an intent to injure, defraud, or deceive, who assists, abets, solicits, or
conspires with such person or insurer to make a false statement or
misrepresentation, is guilty of a:
(1) misdemeanor, for a first offense violation, if the
amount of the economic advantage or benefit received,
or attempted to be received, is less than one thousand dollars.
Upon conviction, the person must be punished by a fine not to exceed
five hundred thousand dollars, or by
imprisonment not to exceed thirty days two years, or by
both such fine and imprisonment;
(2) misdemeanor, felony for a first offense
violation, if the amount of the economic advantage
or benefit received, or attempted to be received, is
one thousand dollars or more but less than five thousand
dollars. Upon conviction, the person must be punished by a fine
not to exceed fifty twenty-five thousand dollars or by
imprisonment for a term not to exceed three five
years, or by both such fine and imprisonment;
(3) felony, for a first offense violation if the amount of
the economic advantage or benefit received, or attempted to be
received, is five thousand dollars or more, or a felony for a
second or subsequent violation, regardless of the amount of
the economic advantage or benefit received, or
attempted to be received. Upon conviction, the person must be
punished by a fine not to exceed fifty thousand dollars or by
imprisonment for a term not to exceed ten years, or by both such
fine and imprisonment and may be fined an amount not to
exceed fifty thousand dollars.
For the purpose of determining the dollar amount of the
economic advantage or benefit, if a person has multiple violations of
this section against the same victim, those violations may be treated
as an aggregate amount or as individual offenses.
Any person or insurer convicted under this section must be ordered
to make full restitution to the victim or victims for any economic
advantage or benefit which has been obtained by the person or
insurer as a result of that violation."
SECTION 5. Section 38-55-550(A) of the 1976 Code, as added by
Section 31A, Part II of Act 497 of 1994, is amended to read:
"(A) In addition to any criminal liability, any person who is found
by a court of competent jurisdiction to have violated any provision of
this article, including Section 38-55-170, is subject to a civil penalty
for each violation as follows:
(1) for a first offense, a fine not to exceed five
ten thousand dollars;
(2) for a second offense, a fine of not less than five thousand
dollars but not to exceed ten twenty-five
thousand dollars;
(3) for a third and subsequent offense, a fine of not less than
ten thousand dollars but not to exceed fifteen
fifty thousand dollars."
SECTION 6. The 1976 Code is amended by adding:
"Section 38-55-555. A conviction for violating any section of Title
38 may be used to enhance any subsequent conviction for violating
Title 38 as a second or subsequent offense."
SECTION 7. Section 38-55-570(B) of the 1976 Code, as added by
Section 31A, Part II of Act 497 of 1994, is amended to read:
"(B)(1) Upon request by the Insurance Fraud Division, any
person, insurer, or authorized agency shall release to the Insurance
Fraud Division any or all information relating to any suspected false
statement or misrepresentation including, but not limited to:
(1)(a) insurance policy information relevant to
the investigation, including any application for such a polity
policy;
(2)(b) policy premium payment records, audits, or other
documents which are available;
(3)(c) history of previous claims, payments,
fees, commission, service bills, or other documents which are
available; and
(4)(d) other information relating to the
investigation of the suspected false statement or misrepresentation.
(2) Any person, insurer, or authorized agency who violates
the provisions of (B)(1) of this section is guilty of a misdemeanor
and, upon conviction, must be punished by a fine not to exceed five
hundred dollars or by imprisonment not to exceed thirty days."
SECTION 8. All proceedings pending and all rights and liabilities
existing, acquired, or incurred at the time this act takes effect are
saved. Except as otherwise provided, the provisions of this act apply
prospectively to crimes and offenses committed on or after the
effective date of this act.
SECTION 9. This act takes effect upon approval by the Governor.
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