NRS 686A.2815 – Nevada “Insurance Fraud” Laws

Under NRS 686A.2815, Nevada law defines insurance fraud as knowingly and willfully providing false information to an insurance company or a government agency in order to obtain benefits for which the person is not legally eligible. A conviction is generally treated as a category D felony punishable by 1 to 4 years in prison, a fine of up to $5000.00, and victim restitution.

The Nevada Attorney General’s Office (AG) is the law enforcement agency that prosecutes these types of claims, many of which involve:

• car insurance,
• health insurance,
• unemployment,
• welfare, or
• workers’ comp.

In this article, our Las Vegas Nevada criminal defense attorneys discuss:

• 1. What is the definition of insurance fraud claims in Nevada?
• 2. How is insurance fraud investigated and prosecuted?
• 3. What are common fraudulent claim crimes?
  • 3 1. Automobiles
  • 3.2. Medical
  • 3.3. Unemployment
  • 3.4. Welfare
  • 3.5. Workers’ compensation

Also see our article on credit card fraud (NRS 205.760).

Making a fraudulent claim is a category D felony in Nevada.

1. What is the definition of insurance fraud claims in Nevada?

Nevada insurance fraud charges are generally prosecuted in three situations:

1. 1. A person makes false representations about a fact material to applications for insurance coverage to get benefits or a lower premium;
   2. A person makes false claims to obtain benefits from an insurance policy he/she is not entitled to; or
   3. A person lies in order to deny benefits and payouts to insurance claim beneficiaries who might otherwise be entitled to them¹

(Other common types of fraud schemes in the insurance industry include asset diversion, fee churning, and premium diversion, where insurance agents and adjusters keep insurance premiums for personal financial gain and not giving them to the underwriter. And people who solicit, conspire, or attempt to commit insurance fraud also face criminal prosecution.)

Insurance fraud is an “intent crime.”² Therefore, people who make innocent mistakes on their applications or unknowingly give false information are not guilty of fraud.

2. How is insurance fraud investigated and prosecuted?

Fraudulent claims are investigated and prosecuted by the Nevada Attorney General’s Insurance Fraud Unit (IFU) task force.

Insurance companies who believe they have been defrauded will generally notify the IFU through the mail or the IFU’s online complaint form. The National Insurance Crime Bureau also makes referrals of suspected fraud cases to the IFU.

Note that Nevada’s Insurance Commissioner’s office handles any civil disputes insurance companies have with their policyholders.

Also note that hard fraud refers to claims that are completely false, while soft fraud refers to otherwise legitimate claims where the claimant may be exaggerating injuries.

The AG’s office investigates NRS 686A.2815 charges in Nevada.

3. What are common fraudulent claim crimes?

3.1. Automobiles

Nevada car insurance fraud occurs when someone falsely claims that their car has been stolen or damaged in an auto accident in order to get money. Auto insurance fraud is a category D felony, carrying:

• one to four (1 – 4) years in prison,
• possibly up to $5,000 in fines,
• the prosecutor’s costs of investigating and prosecuting the case, and
• restitution

3.2. Medical

Health care fraud in Nevada typically occurs when doctors or medical staff:

• falsify patient records,
• fraudulently overbill an insurer, or
• bill for services and health care benefits they never performed.

This felony crime is also known as medical billing-, HMO-, or Medicare fraud.

As a Nevada state crime, medical fraud is a category D felony, carrying:

• one to four (1 – 4) years in prison,
• possibly up to $5,000 in fines,
• the prosecutor’s costs of investigating and prosecuting the case, and
• restitution

As a federal crime, federal health care fraud carries potential penalties of up to 10 years in Federal Prison and/or a fine of up to $250,000.³

3.3. Unemployment

A person commits unemployment insurance (UI) fraud in Nevada when he/she lies for the purpose of wrongfully obtaining UI benefits. A common scenario is a person claiming he/she is unemployed while secretly working an under-the-table job.

Nevada UI fraud is a category D felony, carrying:

• one to four (1 – 4) years in prison,
• possibly up to $5,000 in fines,
• the prosecutor’s costs of investigating and prosecuting the case, and
• restitution

3.4. Welfare

Welfare fraud in Nevada encompasses dozens of possible state and federal offenses. Usually, this crime is committed when someone fraudulently receives or facilitates a wrongful payment of welfare benefits.

Defrauding a welfare insurer is typically a category D felony. Penalties can include:

• denial of future benefits,
• one to four (1 – 4) years in prison,
• possibly up to $5,000 in fines,
• the prosecutor’s costs of investigating and prosecuting the case, and
• restitution

3.5. Worker’s Compensation

A person commits workers’ compensation fraud in the state of Nevada when he/she intentionally lies in order to wrongfully obtain benefits or to deny benefits to someone else.

Defrauding a worker’s compensation insurer is a category D felony regardless of whether it was committed by the applicant or the employer. Penalties for defrauding a workers’ compensation insurer can include:

• denial of future benefits,
• one to four (1 – 4) years in prison
• possibly up to $5,000 in fines,
• the prosecutor’s costs of investigating and prosecuting the case, and
• restitution

Other types of insurance fraud involve homeowners insurance, life insurance,

Contact our law firm for additional help. Our Las Vegas fraud lawyers are available 24/7.

Arrested in California? See our page on California insurance scam crimes.

Arrested in Colorado? See our page on Colorado insurance scam crimes.

Helpful Links

• FBI – Insurance Fraud Bureau
• Coalition Against Insurance Fraud
• National Insurance Crime Bureau (NICB) – Report Fraud
• Insurance Information Institute
• National Association of Insurance Commissioners (NAIC)
• Nevada Department of Insurance

Legal References