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 you are 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
• 4. How do I report insurance fraud in Nevada?

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

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

Nevada insurance fraud charges are generally prosecuted in three situations:

1. You make false representations about a fact material to applications for insurance coverage to get benefits or a lower premium;
2. You make false claims to obtain benefits from an insurance policy you are not entitled to; or
3. You lie in order to deny benefits and payouts to insurance claim beneficiaries who might otherwise be entitled to them¹

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

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 do not give them to the underwriter).

Note that soliciting, conspiring, or attempting to commit insurance fraud is also a crime.

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.

3. What are common fraudulent claim crimes?

3.1. Automobiles

Nevada car insurance fraud occurs when you falsely claim that your 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

You commit unemployment insurance (UI) fraud in Nevada when you lie for the purpose of wrongfully obtaining UI benefits. A common scenario is claiming you are 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 you fraudulently receive or facilitate 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

You commit workers’ compensation fraud in the state of Nevada when you intentionally lie 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

4. How do I report insurance fraud in Nevada?

To report insurance fraud, call the Nevada Attorney General’s Office at either:

• 702-486-3420 (Las Vegas office)
• 775-687-2100 (Reno office)
• 775-684-1100 (Carson City office)

Alternatively, you can complete this complaint form and email it to AGCOMPLAINT@ag.nv.gov. Or you can also submit this complaint form online.

If you simply have a dispute with an insurance company, contact the Insurance Commissioner’s office.

Another option for reporting insurance fraud is to call the National Insurance Crime Bureau (NICB)at 1-800-TEL-NICB (835-6422).

Additional Reading…

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

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Legal References