Healthcare Fraud – Nevada Law & Penalty – NRS § 686A.2815

The Nevada crime of healthcare insurance fraud occurs when medical providers intentionally overbill insurance companies or accept payments to which they are not entitled. Healthcare fraud is a category D felony punishable by:

1. 1 to 4 years in Nevada prison, and
2. fines up to $5,000, and
3. restitution to any victims.

You can also have your medical license suspended or revoked.

In this article, our Las Vegas criminal defense attorneys will address the following key issues regarding Nevada healthcare fraud laws:

• 1. Elements
• 2. Defenses
• 3. Penalties
• 4. Record Seals
• 5. Immigration Consequences
• 6. Related Offenses
• Frequently Asked Questions
• Additional Resources

1. Elements

In Nevada, healthcare fraud occurs when doctors or their staff deliberately swindle health insurance companies out of money they did not earn.¹

Example: Oncologist Dr. Smith treats his patient John with a standard form of chemotherapy. But Dr. Smith deliberately bills John’s insurance program United Healthcare for a more expensive type of medical service covered by John’s health plan. (This type of fraudulent medical records billing for pricier procedures is called upcoding.) Since Dr. Smith is intentionally trying to get United Healthcare to pay him more money than he has eligibility for, Dr. Smith could be convicted of health insurance fraud in Las Vegas.

Here, Dr. Smith would still be criminally liable if United Healthcare had caught the fraud before overpaying. A defendant may be convicted of fraud, regardless of whether the victim loses any money. It does not matter whether the insurer is private or government-funded.

In addition to upcoding, other common examples of health insurance fraud include:

1. Double-billing for medical procedures that were performed only once (“making duplicate claims”);
2. Charging for health care procedures, office visits, surgeries, and tests that were never rendered;
3. Charging for health care procedures or equipment that were unnecessary or excessive;
4. Exaggerating / inflating the costs of performing medical procedures;
5. Falsifying patient records to justify tests and operations that are unnecessary;
6. Using unnecessary equipment or meds in exchange for kickbacks from pharmaceutical companies (such as cash or other gifts);
7. Unbundling services (submitting bills in piecemeal, which usually increases the costs);
8. Using increased billing codes or any other type of false billing; and
9. Conspiring with anyone – or aiding and abetting – do any of the above

Health insurance fraud is also known as “medical billing fraud,” medical insurance fraud, “HMO fraud,” and “Medicare fraud.” In Nevada, cases are prosecuted by the Nevada Attorney General’s Office, not the local district attorney’s office.

Potential Defendants

Note that any type of health care worker — and not just physicians — may be liable for NRS 686A.2815 violations.² Other potential defendants include:

• Physician’s assistants (PAs)
• Dentists
• Chiropractors
• Therapists
• Nurses (RNs)
• Medical equipment suppliers
• Hospital management and staff
• Medical laboratory management and staff
• Drug researchers
• Nursing home or group home management and staff
• Medical support staff, including administrative assistants and record clerks

Federal Health Care Fraud

Health insurance fraud is a crime under both Nevada law and federal law. Depending on the circumstances, you may face fraud charges in both state and federal courts.

The federal crime of health care fraud often involves federal health insurers such as Medicare.³

2. Defenses

Here at Las Vegas Defense Group, we have represented literally thousands of people charged with fraud-related crimes, including healthcare fraud. In our experience, the following two defenses have proven very effective with prosecutors, judges, and juries at getting these charges reduced and dismissed.

1) There Was No Fraudulent Intent

A key element of NRS 686A.2815 is that you intentionally gives a health insurer false information to defraud them. It is no crime to give false information accidentally. This is true even if the mistake causes the health insurer to pay out extra money.⁴

Nevada judges understand that health insurers are confusing bureaucracies with complicated procedures. Plus, they expect that innocent people will make honest errors:

Example: Dr. Jones is a neurosurgeon in Henderson who buys a new CT scan machine that is cheaper to operate than his old one. But by mistake he continues to bill his patients’ insurers for scans done under the old CT machine. Because Dr. Jones had no intention of tricking the insurance companies, his overbilling for healthcare services does not make him criminally liable for health insurance fraud. (However, the insurers may be able to sue Dr. Jones in civil court to recoup the extra money they paid due to his oversight of providing false insurance information.)

Even if Dr. Jones in the above example were prosecuted in federal rather than state court, the criminal charges should still be dismissed. This is because his actions were a pure oversight, not part of a healthcare fraud scheme or artifice.⁵

2) There Was Police Misconduct

Sometimes, Nevada courts dismiss criminal charges solely due to police error, such as:

• Making unlawful arrests,
• Manipulating evidence,
• Coercing a confession, and/or
• Carrying out an unlawful search and seizure⁶

For instance, if law enforcement performs an illegal search while investigating a health insurance fraudulent claim case, then the defendant’s attorney can file a motion to suppress evidence. A suppression motion asks the judge to exclude any evidence obtained from the illegal police search.

If the court grants the motion, the D.A. may be left with insufficient evidence to sustain a conviction for healthcare fraud.

3. Penalties

Health insurance fraud in Nevada is a category D felony. Violating NRS 686A.2815 carries:

• 1 to 4 years in Nevada State Prison,
• Restitution to the insurance company,
• Up to $5,000 (at the judge’s discretion),
• Court costs, and
• Reimbursement costs to the state for investigating and prosecuting the insurance fraud case ⁷

However, prosecutors may be willing to negotiate a charge reduction or even a dismissal.

Depending on the case, healthcare providers may also face suspension or revocation of their professional license. So, in addition to criminal penalties, defendants face the loss of their livelihood.⁸

Federal Penalties

Federal law carries harsher penalties than Nevada law for health insurance fraud. The extent of the sentence depends on whether the patient sustains serious harm or death, as the following table shows.⁹

Federal Healthcare Fraud oOfense	Penalties under 18 USC 1347
If no bodily injury results	Up to 10 years in prison plus possible fines
If serious bodily injury results	Up to 20 years in prison plus possible fines
If death results	Up to life in prison plus possible fines

4. Record Seals

An NRS 686A.2815 conviction can be sealed in the state of Nevada five years after the case ends. However, there is no waiting period for a record seal if the charge gets dismissed.¹⁰

Learn more about getting criminal records sealed in Nevada.

5. Immigration Consequences

Healthcare program fraud is an aggravated felony, which is deportable.¹¹ However, a skilled Nevada criminal defense attorney may be able to persuade the prosecutor to lessen the charge to a non-deportable offense.

Any aliens charged with a crime should retain an attorney immediately in an effort to safeguard their resident status.

6. Related Offenses

Forgery

Forgery (NRS 205.090) occurs when someone intentionally tries to defraud another person or company by using falsified documents. A common example is signing someone else’s name to a contract.

As a category D felony, a Nevada forgery conviction carries one to four years in prison and up to $5,000 in fines plus restitution.

Commercial Bribery

Commercial bribery (NRS 207.295) occurs when a company employee is offered gifts, cash, or benefits in return for making a business decision without the employer’s permission. As a Nevada misdemeanor, violating NRS 207.295 carries up to six months in jail and/or $1,000.

Obtaining Money By False Pretenses

Obtaining money by false pretenses (NRS 205.380) occurs when people knowingly misrepresent themselves to obtain money from someone else relying on their misrepresentation. A common example in Nevada is getting paid for a job the person never performed.

Fraudulently obtaining less than $1,200 is a misdemeanor, carrying up to six months in jail and/or $1,000, plus restitution.

Fraudulently obtaining $1,200 or more is a felony, carrying prison, fines, and restitution.

Illegally Obtaining Prescription Drugs

Illegally obtaining prescription drugs (NRS 453.391) is a category C felony. The Nevada penalty is:

• 1 to 5 years in prison and
• Up to $10,000 in fines.

It does not matter whether the drug is an opioid or a non-addictive medication.

Frequently Asked Questions

What is the difference between health care fraud under NRS 686A.2815 and NRS 422.410?

While NRS 686A.2815 broadly covers insurance fraud (including defrauding private health insurance companies), NRS 422.410 specifically targets fraudulent acts aimed at government-funded public assistance programs, most notably Medicaid and Medicare. If you submit false claims or deceive state or federally-funded health care programs to obtain money or benefits, you will likely be prosecuted under NRS 422.410.

Can I be charged with conspiracy to commit health care fraud?

Yes. Under Nevada law (NRS 199.480), if you enter into an agreement with one or more individuals—such as a doctor colluding with a medical biller or pharmaceutical rep—to engage in fraudulent health care billing, you can be charged with conspiracy to commit fraud. You can face conspiracy charges even if the actual fraudulent claim was never successfully paid out by the insurer.

Is there a specific Nevada law for defrauding Medicaid or public assistance programs?

Yes. While NRS 686A.2815 broadly covers health insurance fraud (including private insurers), offenses involving government-funded public assistance programs can also implicate NRS 422.410 and related statutes. These laws specifically target fraudulent acts, false claims, and deceitful practices designed to unlawfully obtain money or benefits from state-administered welfare and health care programs like Nevada Medicaid.

Can a misunderstanding of billing rules be used as a defense?

Yes. Medical billing is notoriously complex, with thousands of ICD and CPT codes that are frequently updated.

A strong defense strategy is demonstrating that any incorrect billing was the result of a genuine misunderstanding of complex billing practices rather than an intentional scheme to defraud the insurance company. If the prosecution cannot prove you knowingly submitted false claims, the fraud charges cannot stand.

How does proving that the medical services were necessary help my case?

A common allegation in health care fraud cases is that a provider ordered unnecessary tests, procedures, or medical equipment simply to bill the insurance company. If your defense attorney can provide medical records and expert testimony showing that the billed services were legitimate and medically necessary for the patient’s well-being, it directly dismantles the prosecution’s claim that the treatment was fraudulent.

Who investigates health care fraud in Nevada?

Depending on the type of insurance being defrauded, investigations are usually spearheaded by the Nevada Attorney General’s Medicaid Fraud Control Unit (MFCU). If the fraud involves federal programs like Medicare, federal agencies such as the FBI, the DEA, and the Office of Inspector General (OIG) will step in.

What is the statute of limitations for health care fraud in Nevada?

Because health care fraud is a felony in Nevada, prosecutors generally have three years from the date the crime was committed (or discovered) to file state charges. If you are facing federal health care fraud charges, the federal statute of limitations is generally five years.

Can a health care fraud conviction ruin my medical license?

Yes. If you are a doctor, nurse, pharmacist, or other licensed healthcare professional, a felony conviction for health care fraud will be reported to your respective Nevada licensing board (such as the Nevada State Board of Medical Examiners). This typically results in immediate disciplinary action, which can include the suspension or permanent revocation of your medical license, ending your career.

What is “Upcoding” and “Unbundling”?

These are two of the most commonly prosecuted medical billing fraud schemes:

1. Upcoding: Billing an insurance company or Medicaid for a more expensive procedure or service than the one actually provided to the patient.
2. Unbundling: Taking a comprehensive medical procedure that should be billed under a single, cheaper billing code, and separating it into multiple distinct charges to artificially increase the total payout.

Additional Resources:

• Nevada Medicaid Fraud Control Unit (MFCU) — investigates and prosecutes medical provider fraud and patient abuse within Nevada’s Medicaid system.
• Nevada Attorney General Hotline for Health Care Fraud Investigations — provides a direct channel for citizens to report suspected medical billing fraud and patient abuse to state authorities.
• Nevada Division of Public Health and Behavioral Health — regulates state healthcare facilities and promotes public wellness initiatives across Nevada.
• Healthcare Fraud Prevention Partnership Participation, Medicaid.gov — fosters collaboration between the federal government, state agencies, and private insurers to detect and prevent healthcare scams.
• Health Care Fraud Unit, Department of Justice — leads the federal prosecution of complex, multi-million dollar health care fraud schemes nationwide.
• U.S. Attorneys, Department of Justice (DOJ) — represents the federal government in prosecuting civil and criminal health care fraud cases within their respective judicial districts.
• U.S. Department of Health and Human Services – Report Fraud — offers guidelines and online portals for citizens to report Medicare and Medicaid fraud directly to the federal government.
• U.S. Department of Health and Human Services – Whistleblower Protection Coordinator — ensures that individuals reporting healthcare fraud are educated on their rights and protected from employer retaliation.
• FBI – Health Care Fraud (Washington, D.C.) — acts as the primary federal agency investigating both government and private health insurance fraud across the United States.
• Centers for Medicare and Medicaid Services (CMS) — administers national public health care programs and establishes strict billing guidelines to prevent fraudulent claims.
• Office of Inspector General (OIG) — conducts audits and investigations to combat waste, fraud, and abuse in Medicare, Medicaid, and other HHS programs.
• National Correct Coding Initiative — promotes standardized medical coding methodologies to prevent improper billing and inappropriate Medicare payments.

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