Pennsylvania’s Insurance Fraud Statute, 18 Pa. Con. Stat. § 4117, creates a private cause
of action to remedy various types of insurance fraud. See § 4117(g). As § 4117 sounds in fraud,
the Rule 9(b) particularity requirement applies. See, e.g., Champlost Fam. Med. Prac. P.C. v.
State Farm Ins., No. 02-3607, 2003 WL 115475, at *1-2 (E.D. Pa. Jan. 9, 2003) (applying Rule
9(b) standard to § 4117 claims); Am. Health Sys., Inc. v. Visiting Nurse Assn. of Greater
Philadelphia, No. 93-542, 1994 WL 314313, at *10 (E.D. Pa. June 29, 1994) (same); cf. United
States ex rel. Schmidt v. Zimmer, Inc., 386 F.3d 235, 242 n. 9 (3d Cir. 2004) (reminding that
False Claims Act counts must be pleaded with particularity).
State Farm asserts that counterclaim-defendants violated § 4117(a)(2), (a)(3), (a)(5),
(a)(6), (b)(2), and (b)(3). All four claims under § 4117(a) concern counterclaim-defendants’
alleged fraudulent misrepresentation(s) and the purported benefits derived therefrom.8 The
8 Section 4117(a) provides in relevant part: a) Offense defined.—A person commits an offense if the person does any of the following: ... (2) Knowingly and with the intent to defraud any insurer or self-insured, presents or causes to be presented to any insurer or self-insured any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim. (3) Knowingly and with the intent to defraud any insurer or self-insured, assists, abets, solicits or conspires with another to prepare or make any statement that is intended to be presented to any insurer or self-insured in connection with, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim, including information which documents or supports an amount claimed in excess of the actual loss sustained by the claimant. ... (5) Knowingly benefits, directly or indirectly, from the proceeds derived from a violation of this section due to the assistance, conspiracy or urging of any person. (6) Is the owner, administrator or employee of any health care facility and knowingly allows the use of such facility by any person in furtherance of a scheme or conspiracy to violate any of the provisions of this section . . . .