N.Y. Comp. Codes R. & Regs. tit. 10, § 98-1.22
(a) All paper claim forms for health insurance delivered to any person residing or located in this State, in connection with health insurance policies, except health insurance policies for title XVIII of the Federal Social Security Act, or State or local department of social services contracts to be issued or issued for delivery in this State shall, as of the date 90 days from the effective date of these regulations, contain the following statement: "Any person who, knowingly and with intent to defraud any MCO or other person, files a statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, is guilty of committing a fraudulent insurance act, which is a crime and shall be subject to a civil penalty not to exceed $5,000 and the stated value of the claim for each such violation."
(b) Location of warning statements and type size.