Fraud Notice definition

Fraud Notice. Any person who knowingly files a statement of claim containing false or misleading information is subject to criminal and civil penalties. This includes Attending Physician portions of the claim form.
Sample 1Sample 2Sample 3
Fraud Notice. Any person who knowingly files a statement of claim containing false or misleading information is subject to criminal and civil penalties. This includes the Physician Statement portion of the claim form. Claimant name: Claimant SSN:
Sample 1Sample 2
Fraud Notice. Any person who knowingly files a statement of claim containing false or misleading information is subject to criminal and civil penalties. This includes Employer and Attending Physician portions of the claim form. Signed by Title Print name Date Telephone Number ( ) Fax Number ( ) E-mail Address (*Please print) For the purpose of evaluating my eligibility for insurance and eligibility for benefits under an existing policy/certificate including checking for and resolving any issues that may arise regarding incomplete or incorrect information on my application or claim forms, I hereby authorize the disclosure of the following information about me and, if applicable, my dependents, from the sources listed below to Colonial Life & Accident Insurance Company (Colonial Life) and its duly authorized representatives. Health information may be disclosed by any health care provider or institution, health plan or health care clearinghouse that has any records or knowledge about me including prescription drug database or pharmacy benefit manager, or ambulance or other medical transport service. Health information may also be disclosed by any insurance company, Medicare or Medicaid agencies or the Medical Information Bureau (MIB). Health information includes my entire medical record and insurance claim history but does not include psychotherapy notes. Non health information including earnings or employment history or any other facts deemed appropriate by Colonial Life to evaluate my application or claim forms may be disclosed by any entity, person or organization that has these records about me, including but not limited to my employer, employer representative and compensation sources, insurance company, financial institution or governmental entities including departments of public safety and motor vehicle departments. Any information Colonial Life obtains pursuant to this authorization will be used for the purpose of evaluating and administering my claim for benefits. Some information obtained may not be protected by certain federal regulations governing the privacy of health information, but the information is protected by state privacy laws and other applicable laws. Colonial Life will not disclose the information unless permitted or required by those laws. This authorization is valid for two (2) years from its execution or the duration of my claim, whichever is earlier and a copy is as valid as the original. I know that I or my authorized representative may request...
Sample 1Sample 2

Examples of Fraud Notice in a sentence

  • Foreign nurses on contract within the Ministry make up 30 per cent of the nursing workforce.

  • FRAUD NOTICE MAINE: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company.

  • NOTICE IN DISTRICT OF COLUMBIA: FRAUD NOTICE: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person.

  • CL-DI-UPDATE (6-10) P.O. Box 1650 – Little Rock, Arkansas 72203-1650 FRAUD NOTICE AZ Residents Only: Upon written request, we will provide you with information regarding the benefits and provisions of the annuity contract for which you are applying.

  • CL-STD (6-10) Employee’s Statement P.O. Box 1650 – Little Rock, Arkansas 72203-1650 FRAUD NOTICE AZ Residents Only: Upon written request, we will provide you with information regarding the benefits and provisions of the annuity contract for which you are applying.

  • FRAUD NOTICE STATEMENTS1 NOTICE TO CALIFORNIA APPLICANTS: Any person who knowingly makes an application for motor vehicle insurance coverage containing any statement that the applicant resides or is domiciled in this state when, in fact, that applicant resides or is domiciled in a state other than this state, is subject to criminal and civil penalties.

  • FRAUD STATEMENTS FRAUD NOTICE GENERAL STATEMENT: Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and [NY: substantial] civil penalties.

  • For more information on how we handle your data, go to www.wealdliving.com/privacy.DATA PROTECTION AND INVESTIGATING FRAUD NOTICE: We must protect ourpublic funds and so we may use the information you have given on this form to prevent and detect fraud.We may also share this information with other public bodies for the same purpose.

  • FRAUD NOTICE NOTICE TO APPLICANTS OF WASHINGTON: Any person who knowingly, and with the intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any material false information or conceals for the purposes of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties and denial of insurance benefits.

  • Please provide complete name, contact information and specialty of any other treating physicians, facilities or hospitals.NameSpecialtyCity, State FRAUD NOTICE: Any person who knowingly files a statement of claim containing false or misleading informationis subject to criminal and civil penalties.


More Definitions of Fraud Notice

Fraud Notice. Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Sample 1
Fraud Notice. Any person who, with the intent to defraud or knowing that he/ she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may be guilty of the crime of insurance fraud as determined by a court of competent jurisdiction.
Sample 1

Related to Fraud Notice

  • FOIA Notice means a decision notice, enforcement notice and/or an information notice;

  • Prescribed Notice means 28 days or any shorter period of notice for a meeting of members of the Company allowed under the Corporations Act.

  • PAGA Notice means Plaintiff’s September 26, 2019, letter to Xxxxxx Staffing Solution, LLC, among others, and the LWDA providing notice pursuant to Labor Code section 2699.3, subd.(a).

  • CAFA Notice refers to the notice requirements imposed by 28 U.S.C. § 1715(b).

  • Demand Notice has the meaning set forth in Section 2(a)(i).

  • Repurchase Response Notice means a notice delivered by the Indenture Trustee at the direction of the Administrator to a Noteholder or Note Owner indicating that a Repurchase Request is unresolved.

  • Notice of Withdrawal means a notice containing the information set out in Schedule VII;

  • Penalty Notice means a notice given to a Person pursuant to section 5 of this By-law;

  • Denial notice means a board notification denying an application for the issuance or renewal of a license as required by the Act.

  • Second Notice means notice to the Class in a form to be approved by the Court, which shall substantially be in accordance with the notice at Schedule “E”.

  • Required Notice Period means the number of days required notice set forth below applicable to the Aggregate Reduction indicated below: ≤$100,000,000 two Business Days >$100,000,000 to $250,000,000 five Business Days ≥$250,000,000 ten Business Days

  • Exchange Notice has the meaning set forth in Section 2.1(a)(iii).

  • Long Form Notice means the form of notice that shall be posted on the Settlement website created by the Settlement Administrator and shall be available to Settlement Class members by mail on request made to the Settlement Administrator in the form attached as Exhibit 2.

  • OJEU Notice means the contract notice published in the Official Journal of the European Union.

  • Determination Notice is defined in Section 6.1(b)(i) of the Agreement.

  • Nomination Notice means all information and documents that a Nominating Shareholder is required to submit to the Secretary of the Corporation pursuant to Section 3.11f.

  • Change Notice is defined in Section 3.5(a) of this Agreement.

  • Warning Notice means a notice in writing by the Secretary of State to the Academy Trust requiring the Academy Trust to procure the admission of a sufficient number of pupils by such date as he deems appropriate in the circumstances and setting out the consequences of not procuring the admission of a sufficient number of pupils by the date specified in such Warning Notice. 91D) If at any time after signing this Agreement, the Parties agree that by virtue of low pupil numbers the Academy is not financially viable, then the Parties jointly may terminate this Agreement having agreed first the precise terms of termination.

  • Termination Warning Notice means a notice sent by the Secretary of State to the Academy Trust, stating his intention to terminate this Agreement.

  • Breach Notice has the meaning specified in Section 8.2(a);

  • Offeror’s Notice means the notice described in Section 11.3.

  • CFIUS Notice means a joint voluntary notice with respect to the Transactions prepared by the parties hereto and submitted to CFIUS in accordance with the requirements of the CFIUS Statute.

  • decision notice means a written notice of a decision by the Department regarding an individual's eligibility for benefits in a program.

  • Initial Notice shall have the meaning set forth in Section 7.1.

  • Publication Notice means the summary notice of proposed Settlement and hearing for publication substantially in the form attached as Exhibit 3 to Exhibit A.

  • Email Notice means notice of the proposed Settlement to be provided to Settlement Class Members substantially in the form attached hereto as “Exhibit A”.