[Rev. 2/11/2015 11:36:13
AM--2014R2]
CHAPTER 616D - INDUSTRIAL INSURANCE:
PROHIBITED ACTS; PENALTIES; PROSECUTION
GENERAL PROVISIONS
NRS 616D.010 Penalties
and remedies are cumulative; exceptions.
NRS 616D.020 Immunity
from criminal penalty or civil action for libel, slander or similar tort for
disclosure of information relating to violation.
NRS 616D.030 Limitation
of liability of insurer or third-party administrator; administrative fines are
exclusive remedies.
ADMINISTRATIVE PROCEEDINGS
NRS 616D.050 Power
of hearing officers, appeals officers and Administrator when conducting
hearings or other proceedings.
NRS 616D.060 Disciplinary
action by hearing officer or panel: Procedural requirements; powers and duties
of officer or panel; appeals.
NRS 616D.065 Disciplinary
action by appeals officer: Order requiring attorney or representative of party
to pay certain costs incurred because of continuance or delay in scheduled
hearing.
NRS 616D.070 Enforcement
of orders, subpoenas and other procedures relating to hearing.
NRS 616D.080 Fees:
Officers serving subpoenas; witnesses; procedure for payment.
NRS 616D.090 Depositions
of witnesses.
NRS 616D.100 Transcripts:
Introduction in evidence; availability to parties.
NRS 616D.110 Order
to cease business operations if employer fails to provide or maintain coverage
for industrial insurance: Power of Administrator; contents; procedure;
assistance from law enforcement agency.
NRS 616D.115 Failure
to comply with order to cease business operations; penalties; cumulative nature
of penalties.
NRS 616D.120 Administrative
fines and benefit penalties for certain violations; powers of Administrator;
revocation or withdrawal of certificate of self-insurance or registration as
third-party administrator; claim against bond for payment of administrative
fines or benefit penalties.
NRS 616D.130 Investigation
of alleged violation; determination of Administrator.
NRS 616D.140 Benefit
penalties: Appeal of imposition of penalty or determination made by
Administrator; finality of imposition of penalty; payment of penalty; recovery
by Administrator of unpaid penalty.
NRS 616D.145 Administrative
fines: Appeal of imposition of fine; finality of imposition of fine; payment of
fine; recovery by Division of unpaid fine.
NRS 616D.150 Appeal
of decisions of Administrator.
PROHIBITED ACTS
NRS 616D.200 Failure
of employer to provide, secure and maintain compensation: Procedure for
determination and appeal; penalty.
NRS 616D.210 Engagement
in new business after termination of prior business while owing premiums,
interest or penalties to private carriers: Prohibitions; penalties.
NRS 616D.220 Liability
for false statement or failure to report material fact concerning amount of
payroll or misrepresentation of classification or duties of employee as related
to amount of payroll; appeal; penalty.
NRS 616D.230 Failure
of employer to pay amount charged for engaging in certain prohibited acts;
civil liability; additional penalties; disposition of amount collected.
NRS 616D.240 Deduction
from wages of employee prohibited; requirement by employer that employee provide
compensation on own behalf prohibited; enforcement of prohibited acts by
Attorney General.
NRS 616D.250 Refusal
of employer to submit records for inspection; penalty.
NRS 616D.260 Refusal
of employer to produce document for audit; order to compel; penalty for failure
to comply with order.
NRS 616D.270 Failure
to post and maintain notices.
NRS 616D.290 Injury
of minor unlawfully employed.
NRS 616D.300 False
statements or representations to obtain benefits; concealment of material fact
to obtain benefits; penalty.
NRS 616D.310 False
statements or representations concerning employment of person receiving benefits;
penalty.
NRS 616D.320 Employment
of person who is receiving unlawful payments for temporary total disability
prohibited; penalty.
NRS 616D.330 Improper
oral or written communications with treating physician or chiropractor of
injured employee; exceptions; penalty.
FRAUDULENT PRACTICES
NRS 616D.350 Definitions.
NRS 616D.360 Circumstances
under which person is deemed to have knowledge of falsity or deemed to have
made or caused certain action.
NRS 616D.370 False
charges, representations and statements; penalty.
NRS 616D.380 Invoices
containing false information; signature required; presumption.
NRS 616D.390 Certain
acts relating to offer, payment, transfer, acceptance or solicitation of
additional value prohibited; improper use of referral fees; exceptions;
penalty.
NRS 616D.400 Failure
to maintain and make available necessary records; penalty.
NRS 616D.410 Conspiracy
to commit prohibited acts.
NRS 616D.415 Fraud;
conspiracy to commit fraud; penalty.
NRS 616D.420 Provider
of health care convicted of fraudulent practice prohibited from receiving or
accepting payment for accident benefits; penalty.
NRS 616D.430 Civil
penalties for person who receives payment or benefit to which person is not
entitled.
NRS 616D.440 False
claim for payment: Withholding by insurer of payment to provider of health
care; procedure for withholding; appeal.
REPORTING VIOLATIONS
NRS 616D.550 Duty
to report violations to Fraud Control Unit for Industrial Insurance.
NRS 616D.560 Duty
of Administrator and Fraud Control Unit for Industrial Insurance to report and
share information relating to violations.
PROSECUTION
NRS 616D.600 Prosecution
of criminal actions by Attorney General: Prosecution not precluded by
commencement of civil action; duty to furnish information to assist in
prosecution; penalty.
NRS 616D.610 Inspection
of employer’s books, records and payroll by Attorney General; subpoena; court
order; penalty.
NRS 616D.620 Penalty
for certain violations; liability for costs of investigation and prosecution;
contents of judgment of conviction; receipt of certain money by Attorney
General to be used to pay salaries of Fraud Control Unit for Industrial
Insurance.
_________
_________
GENERAL PROVISIONS
NRS 616D.010 Penalties and remedies are cumulative; exceptions. Except as otherwise provided in NRS 616A.020, 616B.600 and 616C.190, no penalty or remedy provided
in this chapter or chapter 616A, 616B or 616C
of NRS is exclusive of any other penalty or remedy, but is cumulative and in
addition to every other penalty or remedy and may be exercised without
exhausting and without regard to any other penalty or remedy provided by those
chapters or any other statute.
(Added to NRS by 1993, 685)—(Substituted
in revision for NRS 616.740)
NRS 616D.020 Immunity from criminal penalty or civil action for libel,
slander or similar tort for disclosure of information relating to violation. No person is subject to any criminal penalty
or civil liability for libel, slander or any similar cause of action in tort if
the person, without malice, discloses information relating to a violation of
any of the provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440,
inclusive, or any fraud in the administration of this chapter or chapter 616A, 616B,
616C or 617
of NRS or in the provision of benefits for industrial insurance.
(Added to NRS by 1993, 685; A 2011, 841)
NRS 616D.030 Limitation of liability of insurer or third-party administrator;
administrative fines are exclusive remedies.
1. No cause of action may be brought or
maintained against an insurer or a third-party administrator who violates any
provision of this chapter or chapter 616A, 616B, 616C
or 617 of NRS.
2. The administrative fines provided for
in NRS 616B.318 and 616D.120 are the exclusive remedies for any violation
of this chapter or chapter 616A, 616B, 616C
or 617 of NRS committed by an insurer or a
third-party administrator.
(Added to NRS by 1995, 2122)
ADMINISTRATIVE PROCEEDINGS
NRS 616D.050 Power of hearing officers, appeals officers and Administrator
when conducting hearings or other proceedings.
1. Appeals officers, the Administrator,
and the Administrator’s designee, in conducting hearings or other proceedings
pursuant to the provisions of chapters 616A
to 616D, inclusive, or chapter 617 of NRS or regulations adopted pursuant to
those chapters may:
(a) Issue subpoenas requiring the attendance of
any witness or the production of books, accounts, papers, records and
documents.
(b) Administer oaths.
(c) Certify to official acts.
(d) Call and examine under oath any witness or
party to a claim.
(e) Maintain order.
(f) Rule upon all questions arising during the
course of a hearing or proceeding.
(g) Permit discovery by deposition or
interrogatories.
(h) Initiate and hold conferences for the
settlement or simplification of issues.
(i) Dispose of procedural requests or similar
matters.
(j) Generally regulate and guide the course of a
pending hearing or proceeding.
2. Hearing officers, in conducting
hearings or other proceedings pursuant to the provisions of chapters 616A to 616D,
inclusive, or chapter 617 of NRS or
regulations adopted pursuant to those chapters, may:
(a) Issue subpoenas requiring the attendance of
any witness or the production of books, accounts, papers, records and documents
that are relevant to the dispute for which the hearing or other proceeding is
being held.
(b) Maintain order.
(c) Permit discovery by deposition or
interrogatories.
(d) Initiate and hold conferences for the
settlement or simplification of issues.
(e) Dispose of procedural requests or similar
matters.
(f) Generally regulate and guide the course of a
pending hearing or proceeding.
(Added to NRS by 1975, 761; A 1977, 313; 1979, 1044; 1981, 1139, 1461; 1983, 355; 1991, 832, 2402; 1993, 708; 1999, 227, 1728, 1737)
NRS 616D.060 Disciplinary action by hearing officer or panel: Procedural
requirements; powers and duties of officer or panel; appeals.
1. Any disciplinary action taken by a hearing
officer or panel pursuant to NRS 616A.467
is subject to the same procedural requirements which apply to disciplinary
actions taken by the Commissioner or Administrator, and the board or panel has
the same powers and duties given to the Commissioner or Administrator in
relation thereto.
2. A decision of the hearing officer or
panel relating to the imposition of an administrative fine is a final decision
in a contested case. Any party aggrieved by a decision of the officer or panel
to withdraw the certification of a self-insured employer or an association of
self-insured public or private employers or the authorization of a private
carrier may appeal that decision to the Commissioner.
(Added to NRS by 1983, 1532; A 1993, 709; 1995, 2014)
NRS 616D.065 Disciplinary action by appeals officer: Order requiring attorney
or representative of party to pay certain costs incurred because of continuance
or delay in scheduled hearing.
1. An appeals officer, in conducting
hearings or other proceedings pursuant to the provisions of chapters 616A to 616D,
inclusive, or chapter 617 of NRS or
regulations adopted pursuant to those chapters, may order the attorney or
representative of a party to pay any costs that are incurred by the Hearings
Division of the Department of Administration for a court reporter or an
interpreter.
2. Before ordering the payment of such
costs, the appeals officer must find that the costs were incurred because the
attorney or representative of a party caused a continuance or delay in a
scheduled hearing by the failure of the attorney or representative, as
applicable, without good cause, to comply with an order of the appeals officer
or a regulation adopted pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS.
(Added to NRS by 1997, 3091; A 1999, 227)
NRS 616D.070 Enforcement of orders, subpoenas and other procedures relating
to hearing. If any person:
1. Disobeys an order of an appeals
officer, a hearing officer, the Administrator or the Administrator’s designee,
or a subpoena issued by the Administrator, Administrator’s designee, appeals
officer, hearing officer, inspector or examiner;
2. Refuses to permit an inspection; or
3. As a witness, refuses to testify to any
matter for which the person may be lawfully interrogated,
Ê the district
judge of the county in which the person resides, on application of the appeals
officer, the hearing officer, the Administrator or the Administrator’s
designee, shall compel obedience by attachment proceedings as for contempt, as
in the case of disobedience of the requirements of subpoenas issued from the
court on a refusal to testify therein.
[48:168:1947; 1943 NCL § 2680.48]—(NRS A 1975, 762; 1977, 313; 1979, 1043; 1981, 1139, 1461; 1983, 356; 1993, 709; 1999, 1729)
NRS 616D.080 Fees: Officers serving subpoenas; witnesses; procedure for
payment.
1. Each officer who serves a subpoena is
entitled to receive the same fees as a sheriff.
2. Each witness who appears, in obedience
to a subpoena which has been issued pursuant to this chapter or chapter 616A, 616B,
616C or 617
of NRS, before an appeals officer, a hearing officer, the Administrator or the
Administrator’s designee, is entitled to receive for his or her attendance the
fees and mileage provided for witnesses in civil cases in courts of record. For
subpoenas issued on behalf of this State or an officer or agency thereof, the
fees and mileage are not required to be tendered at the same time that the
subpoena is delivered to the person named therein.
3. The appeals officer, hearing officer,
Administrator or the Administrator’s designee shall:
(a) Authorize payment from his or her
administrative budget of the fees and mileage due to such a witness; or
(b) Impose those costs upon the party at whose
instance the witness was subpoenaed or, for good cause shown, upon any other
party.
[49:168:1947; 1943 NCL § 2680.49]—(NRS A 1975, 762; 1977, 313; 1979, 1043; 1981, 1462; 1983, 356, 1293; 1993, 709; 1999, 227, 1729, 1738)
NRS 616D.090 Depositions of witnesses.
1. In an investigation, the Administrator
or a hearing officer may cause depositions of witnesses residing within or
without the State to be taken in the manner prescribed by law and Nevada Rules
of Civil Procedure for taking depositions in civil actions in courts of record.
2. After the initiation of a claim under
the provisions of this chapter or chapter 616A,
616B, 616C
or 617 of NRS, in which a claimant or other
party is entitled to a hearing on the merits, any party to the proceeding may,
in the manner prescribed by law and the Nevada Rules of Civil Procedure for
taking written interrogatories and depositions in civil actions in courts of
record:
(a) Serve upon any other party written
interrogatories to be answered by the party served; or
(b) Take the testimony of any person, including a
party, by deposition upon oral examination.
[50:168:1947; 1943 NCL § 2680.50]—(NRS A 1975, 762; 1979, 1043; 1981, 1462)—(Substituted
in revision for NRS 616.240)
NRS 616D.100 Transcripts: Introduction in evidence; availability to parties.
1. A transcribed copy of the evidence and
proceedings, or any specific part thereof, of any final hearing or
investigation, made by a stenographer appointed by an appeals officer, a
hearing officer, the Administrator or the Administrator’s designee, being
certified by that stenographer to be a true and correct transcript of the
testimony in the final hearing or investigation, or of a particular witness, or
of a specific part thereof, and carefully compared by the stenographer with his
or her original notes, and to be a correct statement of the evidence and
proceedings had on the final hearing or investigation so purporting to be taken
and transcribed, may be received in evidence with the same effect as if the
stenographer had been present and testified to the facts so certified.
2. A copy of the transcript must be
furnished on demand to any party upon the payment of the fee required for
transcripts in courts of record.
[51:168:1947; NCL § 2680.51]—(NRS A 1967, 39; 1973,
1597; 1975, 762; 1977,
314; 1979,
1044; 1981,
1462; 1983,
356; 1993,
710; 1999,
1730)
NRS 616D.110 Order to cease business operations if employer fails to provide
or maintain coverage for industrial insurance: Power of Administrator;
contents; procedure; assistance from law enforcement agency.
1. In addition to any other remedy
provided for by law, if any employer within the provisions of NRS 616B.633 fails to provide and secure
compensation, or fails to maintain such compensation, under the terms of chapters 616A to 616D,
inclusive, or chapter 617 of NRS, the
Administrator may, in order to protect the employees of the employer from the
effect of not having industrial insurance coverage and upon compliance with the
requirements of subsection 2, order the immediate cessation of all business
operations at the place of employment or jobsite until such time as the
employer performs all acts and duties enjoined upon the employer by chapters 616A to 616D,
inclusive, or chapter 617 of NRS as
determined necessary by the Administrator in order to provide, secure and
maintain compensation under those chapters.
2. The order must:
(a) Include a reference to the particular sections
of the statutes or regulations alleged to have been violated, and a short,
plain statement of the facts alleged to constitute the violation.
(b) Provide an opportunity for hearing to the
employer on a date fixed in the order which must not be less than 5 nor more
than 15 days after the date of the order, unless upon demand of the employer
the date is advanced to the next business day after the demand is made to the
Administrator.
Ê An order for
summary suspension issued pursuant to this subsection must be endorsed with the
date and hour of issuance and entered of record in the office of the
Administrator.
3. Immediately upon receiving an order to
cease business operations under subsection 1, an employer shall order all
employees or other persons to leave the place of employment or jobsite and
shall cease all business operations thereat.
4. Upon request by the Administrator, any
law enforcement agency in this State shall render any assistance necessary to
carry out the requirement of subsection 3, including but not limited to
preventing any employee or other person from remaining at the place of
employment or jobsite.
(Added to NRS by 1973, 585; A 1981, 1497; 1999, 228)
NRS 616D.115 Failure to comply with order to cease business operations;
penalties; cumulative nature of penalties.
1. A person shall not knowingly fail to
comply with an order issued by the Administrator pursuant to NRS 616D.110 to cease immediately all business
operations at a place of employment or jobsite.
2. A person who is convicted of violating
the provisions of subsection 1 is guilty of a misdemeanor.
3. A criminal penalty imposed pursuant to
this section is in addition to any civil penalty or other remedy available
pursuant to another statute.
(Added to NRS by 2003, 371)
NRS 616D.120 Administrative fines and benefit penalties for certain
violations; powers of Administrator; revocation or withdrawal of certificate of
self-insurance or registration as third-party administrator; claim against bond
for payment of administrative fines or benefit penalties.
1. Except as otherwise provided in this
section, if the Administrator determines that an insurer, organization for
managed care, health care provider, third-party administrator, employer or
employee leasing company has:
(a) Induced a claimant to fail to report an
accidental injury or occupational disease;
(b) Without justification, persuaded a claimant
to:
(1) Settle for an amount which is less
than reasonable;
(2) Settle for an amount which is less
than reasonable while a hearing or an appeal is pending; or
(3) Accept less than the compensation
found to be due the claimant by a hearing officer, appeals officer, court of
competent jurisdiction, written settlement agreement, written stipulation or
the Division when carrying out its duties pursuant to chapters 616A to 617,
inclusive, of NRS;
(c) Refused to pay or unreasonably delayed
payment to a claimant of compensation or other relief found to be due the
claimant by a hearing officer, appeals officer, court of competent
jurisdiction, written settlement agreement, written stipulation or the Division
when carrying out its duties pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS, if the refusal or delay occurs:
(1) Later than 10 days after the date of
the settlement agreement or stipulation;
(2) Later than 30 days after the date of
the decision of a court, hearing officer, appeals officer or the Division,
unless a stay has been granted; or
(3) Later than 10 days after a stay of the
decision of a court, hearing officer, appeals officer or the Division has been
lifted;
(d) Refused to process a claim for compensation
pursuant to chapters 616A to 616D, inclusive, or chapter 617
of NRS;
(e) Made it necessary for a claimant to initiate
proceedings pursuant to chapters 616A to 616D, inclusive, or chapter 617
of NRS for compensation or other relief found to be due the claimant by a
hearing officer, appeals officer, court of competent jurisdiction, written
settlement agreement, written stipulation or the Division when carrying out its
duties pursuant to chapters 616A to 616D, inclusive, or chapter 617
of NRS;
(f) Failed to comply with the Division’s
regulations covering the payment of an assessment relating to the funding of
costs of administration of chapters 616A to
617, inclusive, of NRS;
(g) Failed to provide or unreasonably delayed
payment to an injured employee or reimbursement to an insurer pursuant to NRS 616C.165;
(h) Engaged in a pattern of untimely payments to
injured employees; or
(i) Intentionally failed to comply with any
provision of, or regulation adopted pursuant to, this chapter or chapter 616A, 616B,
616C or 617
of NRS,
Ê the
Administrator shall impose an administrative fine of $1,500 for each initial
violation, or a fine of $15,000 for a second or subsequent violation.
2. Except as otherwise provided in chapters 616A to 616D,
inclusive, or chapter 617 of NRS, if the
Administrator determines that an insurer, organization for managed care, health
care provider, third-party administrator, employer or employee leasing company
has failed to comply with any provision of this chapter or chapter 616A, 616B,
616C or 617
of NRS, or any regulation adopted pursuant thereto, the Administrator may take
any of the following actions:
(a) Issue a notice of correction for:
(1) A minor violation, as defined by
regulations adopted by the Division; or
(2) A violation involving the payment of
compensation in an amount which is greater than that required by any provision
of this chapter or chapter 616A, 616B, 616C
or 617 of NRS, or any regulation adopted
pursuant thereto.
Ê The notice
of correction must set forth with particularity the violation committed and the
manner in which the violation may be corrected. The provisions of this section
do not authorize the Administrator to modify or negate in any manner a
determination or any portion of a determination made by a hearing officer,
appeals officer or court of competent jurisdiction or a provision contained in
a written settlement agreement or written stipulation.
(b) Impose an administrative fine for:
(1) A second or subsequent violation for
which a notice of correction has been issued pursuant to paragraph (a); or
(2) Any other violation of this chapter or
chapter 616A, 616B, 616C
or 617 of NRS, or any regulation adopted pursuant
thereto, for which a notice of correction may not be issued pursuant to
paragraph (a).
Ê The fine
imposed must not be greater than $375 for an initial violation, or more than
$3,000 for any second or subsequent violation.
(c) Order a plan of corrective action to be
submitted to the Administrator within 30 days after the date of the order.
3. If the Administrator determines that a
violation of any of the provisions of paragraphs (a) to (e), inclusive, (h) or
(i) of subsection 1 has occurred, the Administrator shall order the insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company to pay to the claimant a benefit penalty:
(a) Except as otherwise provided in paragraph
(b), in an amount that is not less than $5,000 and not greater than $50,000; or
(b) Of $3,000 if the violation involves a late
payment of compensation or other relief to a claimant in an amount which is
less than $500 or which is not more than 14 days late.
4. To determine the amount of the benefit
penalty, the Administrator shall consider the degree of physical harm suffered
by the injured employee or the dependents of the injured employee as a result
of the violation of paragraph (a), (b), (c), (d), (e), (h) or (i) of subsection
1, the amount of compensation found to be due the claimant and the number of
fines and benefit penalties, other than a benefit penalty described in
paragraph (b) of subsection 3, previously imposed against the insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company pursuant to this section. The
Administrator shall also consider the degree of economic harm suffered by the
injured employee or the dependents of the injured employee as a result of the
violation of paragraph (a), (b), (c), (d), (e), (h) or (i) of subsection 1.
Except as otherwise provided in this section, the benefit penalty is for the
benefit of the claimant and must be paid directly to the claimant within 10
days after the date of the Administrator’s determination. If the claimant is
the injured employee and the claimant dies before the benefit penalty is paid
to him or her, the benefit penalty must be paid to the estate of the claimant.
Proof of the payment of the benefit penalty must be submitted to the
Administrator within 10 days after the date of the Administrator’s
determination unless an appeal is filed pursuant to NRS
616D.140. Any compensation to which the claimant may otherwise be entitled
pursuant to chapters 616A to 616D, inclusive, or chapter 617
of NRS must not be reduced by the amount of any benefit penalty received
pursuant to this subsection. To determine the amount of the benefit penalty in
cases of multiple violations occurring within a certain period of time, the
Administrator shall adopt regulations which take into consideration:
(a) The number of violations within a certain
number of years for which a benefit penalty was imposed; and
(b) The number of claims handled by the insurer,
organization for managed care, health care provider, third-party administrator,
employer or employee leasing company in relation to the number of benefit
penalties previously imposed within the period of time prescribed pursuant to
paragraph (a).
5. In addition to any fine or benefit
penalty imposed pursuant to this section, the Administrator may assess against
an insurer who violates any regulation concerning the reporting of claims
expenditures or premiums received that are used to calculate an assessment an
administrative penalty of up to twice the amount of any underpaid assessment.
6. If:
(a) The Administrator determines that a person
has violated any of the provisions of NRS 616D.200,
616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440,
inclusive; and
(b) The Fraud Control Unit for Industrial
Insurance of the Office of the Attorney General established pursuant to NRS 228.420 notifies the Administrator
that the Unit will not prosecute the person for that violation,
Ê the
Administrator shall impose an administrative fine of not more than $15,000.
7. Two or more fines of $1,000 or more
imposed in 1 year for acts enumerated in subsection 1 must be considered by the
Commissioner as evidence for the withdrawal of:
(a) A certificate to act as a self-insured
employer.
(b) A certificate to act as an association of
self-insured public or private employers.
(c) A certificate of registration as a
third-party administrator.
8. The Commissioner may, without complying
with the provisions of NRS 616B.327
or 616B.431, withdraw the
certification of a self-insured employer, association of self-insured public or
private employers or third-party administrator if, after a hearing, it is shown
that the self-insured employer, association of self-insured public or private
employers or third-party administrator violated any provision of subsection 1.
9. If the Administrator determines that a
vocational rehabilitation counselor has violated the provisions of NRS 616C.543, the Administrator may
impose an administrative fine on the vocational rehabilitation counselor of not
more than $250 for a first violation, $500 for a second violation and $1,000
for a third or subsequent violation.
10. The Administrator may make a claim
against the bond required pursuant to NRS
683A.0857 for the payment of any administrative fine or benefit penalty
imposed for a violation of the provisions of this section.
(Added to NRS by 1981, 1453; A 1985, 864; 1989, 1593; 1991, 2427; 1993, 756, 758, 1874; 1995, 531, 542, 1642, 2160; 1997, 533, 535, 3219; 1999, 1796, 3148; 2001, 2455; 2003, 1677; 2005, 1101; 2007, 3363; 2009, 1131,
3040; 2011, 120)
NRS 616D.130 Investigation of alleged violation; determination of
Administrator.
1. Upon receipt of a complaint for a
violation of subsection 1 of NRS 616D.120, or if
the Administrator has reason to believe that such a violation has occurred, the
Administrator shall cause to be conducted an investigation of the alleged
violation. Except as otherwise provided in subsection 2, the Administrator
shall, within 30 days after initiating the investigation:
(a) Render a determination. The determination
must include the Administrator’s findings of fact and, if the Administrator
determines that a violation has occurred, one or more of the following:
(1) The amount of any fine required to be
paid pursuant to NRS 616D.120.
(2) The amount of any benefit penalty
required to be paid to a claimant pursuant to NRS
616D.120.
(3) A plan of corrective action to be
taken by the insurer, organization for managed care, health care provider,
third-party administrator or employer, including the manner and time within
which the violation must be corrected.
(4) A requirement that notice of the
violation be given to the appropriate agency that regulates the activities of
the violator.
(b) Notify the Commissioner if the Administrator
determines that a violation was committed by a self-insured employer,
association of self-insured public or private employers or third-party
administrator.
2. Upon receipt of a complaint for any
violation of paragraph (a), (b), (c) or (d) of subsection 1 of NRS 616D.120, or if the Administrator has reason to
believe that such a violation has occurred, the Administrator shall complete
the investigation required by subsection 1 within 60 days and, within 30 days
after the completion of the investigation, render a determination and notify
the Commissioner if the Administrator determines that a violation was committed
by a self-insured employer, association of self-insured public or private
employers or third-party administrator.
3. If, based upon the Administrator’s
findings of fact, the Administrator determines that a violation has not
occurred, the Administrator shall issue a determination to that effect.
(Added to NRS by 1995, 1637; A 2003, 1680)
NRS 616D.140 Benefit penalties: Appeal of imposition of penalty or
determination made by Administrator; finality of imposition of penalty; payment
of penalty; recovery by Administrator of unpaid penalty.
1. If a person wishes to contest a
decision of the Administrator to impose or refuse to impose a benefit penalty
pursuant to NRS 616D.120, the person must file a
notice of appeal with an appeals officer in accordance with this section. The
notice of appeal must set forth the reasons the proposed benefit penalty should
or should not be imposed.
2. A person who is aggrieved by:
(a) A written determination of the Administrator;
or
(b) The failure of the Administrator to respond
within 90 days to a written request mailed to the Administrator by the person
who is aggrieved,
Ê may appeal
from the determination or failure to respond by filing a request for a hearing
before an appeals officer. The request must be filed within 30 days after the
date on which the notice of the Administrator’s determination was mailed by the
Administrator or within 100 days after the date on which the unanswered written
request was mailed to the Administrator, as applicable. The failure of the
Administrator to respond to a written request for a determination within 90
days after receipt of the request shall be deemed by the appeals officer to be
a denial of the request.
3. If a notice of appeal is not filed as
required by this section, the imposition of or refusal to impose the benefit
penalty shall be deemed a final order and is not subject to review by any court
or agency.
4. A hearing held pursuant to this section
must be conducted by the appeals officer as a hearing de novo. The appeals
officer shall render a written decision on the appeal. Except as otherwise
provided in this section, the provisions of NRS 616C.345 to 616C.385, inclusive, apply to an appeal
filed pursuant to this section.
5. A benefit penalty imposed pursuant to NRS 616D.120 must be paid to the claimant on whose
behalf it is imposed. If such a payment is not made within the period required
by NRS 616D.120, the benefit penalty may be
recovered in a civil action brought by the Administrator on behalf of the
claimant in a court of competent jurisdiction in the county in which the
claimant resides, in which the violation occurred or in which the person who is
required to pay the benefit penalty has his or her principal place of business.
6. Any party aggrieved by a decision
issued pursuant to this section by an appeals officer may appeal the decision
directly to the district court.
(Added to NRS by 1993, 691; A 1995, 1639; 2003, 1681)
NRS 616D.145 Administrative fines: Appeal of imposition of fine; finality of
imposition of fine; payment of fine; recovery by Division of unpaid fine.
1. If a person wishes to contest a
decision of the Administrator to impose an administrative fine pursuant to this
chapter or chapter 616A, 616B, 616C
or 617 of NRS, the person must file a notice
of appeal with an appeals officer in accordance with this section. The notice
of appeal must set forth the reasons the proposed administrative fine should
not be imposed.
2. A person who is aggrieved by a written
determination of the Administrator may appeal from the determination by filing
a request for a hearing before an appeals officer. The request must be filed
within 30 days after the date on which the notice of the Administrator’s
determination was mailed by the Administrator.
3. If a notice of appeal is not filed as
required by this section, the imposition of the administrative fine shall be
deemed a final order and is not subject to review by any court or agency.
4. An administrative fine imposed pursuant
to this chapter or chapter 616A, 616B, 616C
or 617 of NRS must be paid to the Division.
If the violation for which the fine is levied was committed by a person while
acting within the course and scope of the person’s agency or employment, the
fine must be paid by the person’s principal or employer. The fine may be
recovered in a civil action brought in the name of the Division in a court of
competent jurisdiction in the county in which the violation occurred or in which
the person against whom the fine is levied has his or her principal place of
business.
(Added to NRS by 2003, 1677)
NRS 616D.150 Appeal of decisions of Administrator. Except
as otherwise provided in NRS 616D.140, 616C.220 and 617.401, any party who is aggrieved by a
decision of the Administrator may appeal that decision directly to the district
court.
(Added to NRS by 1981, 1454; A 1987, 655; 1991, 2401; 1995, 1640)—(Substituted
in revision for NRS 616.221)
PROHIBITED ACTS
NRS 616D.200 Failure of employer to provide, secure and maintain
compensation: Procedure for determination and appeal; penalty.
1. If the Administrator finds that an
employer within the provisions of NRS
616B.633 has failed to provide and secure compensation as required by the
terms of chapters 616A to 616D,
inclusive, or chapter 617 of NRS or that the
employer has provided and secured that compensation but has failed to maintain
it, the Administrator shall make a determination thereon and may charge the
employer an amount equal to the sum of:
(a) The premiums that would otherwise have been
owed to a private carrier pursuant to the terms of chapters 616A to 616D,
inclusive, or chapter 617 of NRS, as
determined by the Administrator based upon the manual rates adopted by the
Commissioner, for the period that the employer was doing business in this State
without providing, securing or maintaining that compensation, but not to exceed
6 years; and
(b) Interest at a rate determined pursuant to NRS 17.130 computed from the time that the
premiums should have been paid.
Ê The money
collected pursuant to this subsection must be paid into the Uninsured
Employers’ Claim Account.
2. The Administrator shall deliver a copy
of his or her determination to the employer. An employer who is aggrieved by
the determination of the Administrator may appeal from the determination
pursuant to subsection 2 of NRS 616D.220.
3. Any employer within the provisions of NRS 616B.633 who fails to provide,
secure or maintain compensation as required by the terms of chapters 616A to 616D,
inclusive, or chapter 617 of NRS, shall be
punished as follows:
(a) Except as otherwise provided in paragraph
(b), if it is a first offense, for a misdemeanor.
(b) If it is a first offense and, during the
period the employer was doing business in this State without providing,
securing or maintaining compensation, one of his or her employees suffers an
injury arising out of and in the course of his or her employment that results
in substantial bodily harm to the employee or the death of the employee, for a
category C felony punishable by imprisonment in the state prison for a minimum
term of not less than 1 year and a maximum term of not more than 5 years and by
a fine of not less than $1,000 nor more than $50,000.
(c) If it is a second or subsequent offense
committed within 7 years after the previous offense, for a category C felony
punishable by imprisonment in the state prison for a minimum term of not less
than 1 year and a maximum term of not more than 5 years and by a fine of not
less than $1,000 nor more than $50,000.
4. In addition to any other penalty
imposed pursuant to paragraph (b) or (c) of subsection 3, the court shall order
the employer to:
(a) Pay restitution to an insurer who has
incurred costs as a result of the violation in an amount equal to the costs
that have been incurred minus any costs incurred that have otherwise been
recovered; and
(b) Reimburse the Uninsured Employers’ Claim
Account for all payments made from the account on the employer’s behalf,
including any benefits, administrative costs or attorney’s fees paid from the
account, that have not otherwise been recovered pursuant to NRS 616C.220 or 617.401, or included in a civil judgment
or a summary judgment entered pursuant to NRS
616C.223 or 617.4015.
5. Any criminal penalty imposed pursuant
to subsections 3 and 4 must be in addition to the amount charged pursuant to
subsection 1.
[32:168:1947; A 1949, 659; 1943 NCL § 2680.32]—(NRS A
1967, 636; 1981,
1498; 1991,
2426; 1993,
754; 1995,
1873; 1997,
568, 570,
1191, 1442, 1457, 3222, 3224; 1999, 228, 250, 658, 1730, 1738, 1739, 1799; 2001, 59, 2769; 2011, 895)
NRS 616D.210 Engagement in new business after termination of prior business
while owing premiums, interest or penalties to private carriers: Prohibitions;
penalties.
1. Any person who:
(a) Is the legal or beneficial owner of 25
percent or more of a business which terminates operations while owing a
premium, interest or penalty to a private carrier and becomes, or induces or
procures another person to become, the legal or beneficial owner of 25 percent
or more of a new business engaging in similar operations; or
(b) Knowingly aids or abets another person in
carrying out such conduct,
Ê is liable in
a civil action for the payment of any premium, interest and penalties owed to
the private carrier and the reasonable costs incurred by the private carrier to
investigate and act upon such conduct.
2. Any person who:
(a) Is the legal or beneficial owner of 25
percent or more of a business which terminates operations while owing money to
the Division for any unpaid administrative fine imposed or benefit penalty
ordered pursuant to NRS 616D.120, unpaid premium
or interest charged pursuant to NRS 616D.200 or
payments made from the Uninsured Employers’ Claim Account pursuant to NRS 616C.220 or 617.401, including attorney’s fees,
administrative costs, interest or penalties, and becomes, or induces or
procures another person to become, the legal or beneficial owner of 25 percent
or more of a new business engaging in similar operations; or
(b) Knowingly aids or abets another person in
carrying out such conduct,
Ê is liable
for the payment of any amount owed to the Division and the reasonable costs
incurred by the Division to investigate and act upon such conduct.
3. An insurer shall not knowingly insure
any business which engages in the conduct described in:
(a) Subsection 1 unless the premium and any
interest and penalties owed to the prior insurer have been paid to that
insurer; or
(b) Subsection 2 unless the amount due the
Division pursuant to NRS 616C.220, 616D.120, 616D.200 or 617.401, including any attorney’s fees,
administrative costs, interest and penalties, has been paid to the Division.
4. As used in this section, “business”
includes, but is not limited to, a firm, sole proprietorship, general or
limited partnership, voluntary association or private corporation.
(Added to NRS by 1993, 685; A 1995, 2033; 1999, 1731, 1800; 2011, 896)
NRS 616D.220 Liability for false statement or failure to report material fact
concerning amount of payroll or misrepresentation of classification or duties
of employee as related to amount of payroll; appeal; penalty.
1. If the Administrator finds that any
employer or any employee, officer or agent of any employer has knowingly:
(a) Made a false statement or has knowingly
failed to report a material fact concerning the amount of payroll upon which a
premium is based; or
(b) Misrepresented the classification or duties
of an employee as they relate to the amount of payroll upon which a premium is
based,
Ê the
Administrator shall make a determination thereon and charge the employer’s
account an amount equal to the amount of the premium that would have been due
had the proper information been submitted. The Administrator shall deliver a
copy of the determination to the employer. The money collected pursuant to this
subsection must be paid into the Uninsured Employers’ Claim Account.
2. An employer who is aggrieved by the
determination of the Administrator may appeal from the determination by filing
a request for a hearing. The request must be filed within 30 days after the
date on which a copy of the determination was delivered to the employer. The
Administrator shall hold a hearing within 30 days after the Administrator
receives the request. The determination of the Administrator made pursuant to a
hearing is a final decision for the purposes of judicial review. The amount of
the determination as finally decided by the Administrator becomes due within 30
days after the determination is served on the employer.
3. A person who knowingly:
(a) Makes a false statement or representation or
who knowingly fails to report a material fact concerning the amount of payroll
upon which a premium is based; or
(b) Misrepresents the classification or duties of
an employee as they relate to the amount of payroll upon which a premium is
based,
Ê is guilty of
a gross misdemeanor. Any criminal penalty imposed must be in addition to the
amount charged pursuant to subsection 1.
[81:168:1947; A 1951, 485]—(NRS A 1971, 154; 1981, 1498; 1989, 743; 1991, 2427; 1993, 755; 1995, 1874; 1997, 585, 1443, 1457; 1999, 1731; 2001, 2770; 2011, 842)
NRS 616D.230 Failure of employer to pay amount charged for engaging in
certain prohibited acts; civil liability; additional penalties; disposition of
amount collected.
1. An employer who fails to pay an amount
of money charged to the employer pursuant to the provisions of NRS 616D.200 or 616D.220
is liable in a civil action commenced by the Attorney General for:
(a) Any amount charged to the employer by the
Administrator pursuant to NRS 616D.200 or 616D.220;
(b) Not more than $10,000 for each act of willful
deception;
(c) An amount equal to three times the total
amount of the reasonable expenses incurred by the State in enforcing this
section; and
(d) Payment of interest on the amount charged at
the rate fixed pursuant to NRS 99.040
for the period from the date upon which the amount charged was due to the date
upon which the amount charged is paid.
2. A criminal action need not be brought
against an employer described in subsection 1 before civil liability attaches
under this section.
3. Any payment of money charged pursuant
to the provisions of NRS 616D.200 or 616D.220 and collected pursuant to paragraph (a) or
(d) of subsection 1 must be paid into the Uninsured Employers’ Claim Account.
4. Any penalty collected pursuant to
paragraph (b) or (c) of subsection 1 must be used to pay the salaries and other
expenses of the Fraud Control Unit for Industrial Insurance established
pursuant to the provisions of NRS 228.420.
Any money remaining at the end of any fiscal year does not revert to the State
General Fund.
(Added to NRS by 1995, 1871; A 1997, 1443; 2001, 2771)
NRS 616D.240 Deduction from wages of employee prohibited; requirement by
employer that employee provide compensation on own behalf prohibited;
enforcement of prohibited acts by Attorney General.
1. Any employer who makes any charge
against any employee or who deducts from the wages of any employee any sum of
money to meet the costs, in whole or in part, of the liability incurred by the
employer by reason of his or her acceptance or rejection of chapters 616A to 616D,
inclusive, or chapter 617 of NRS is guilty of
a gross misdemeanor.
2. An employer who is required to provide
compensation pursuant to the provisions of chapters
616A to 616D, inclusive, or chapter 617 of NRS and who requires an employee to
provide or secure such compensation on the employee’s own behalf is guilty of a
gross misdemeanor.
3. Any employer violating any provision of
this section must be prosecuted by the Attorney General upon complaint of any
employee who, as determined by the Attorney General, submits proper evidence of
a violation.
[38:168:1947; 1943 NCL § 2680.38]—(NRS A 1967, 637; 1987, 599; 1991, 2427; 1993, 756; 1995, 171; 1999, 229)
NRS 616D.250 Refusal of employer to submit records for inspection; penalty.
1. A self-insured employer, a member of an
association of self-insured public or private employers or an employer insured
by a private carrier who refuses to submit his or her books, records and
payroll to the Administrator or the private carrier for inspection as provided
by NRS 616A.485 is subject to a
penalty of $1,000 for each offense, to be collected by a civil action in the
name of the Administrator or the private carrier, as applicable.
2. The person who makes such refusal is
guilty of a misdemeanor.
[Part 80:168:1947; 1943 NCL § 2680.80]—(NRS A 1981, 1498; 1993, 1873; 1995, 2034; 1999, 1800, 2417; 2001, 115)
NRS 616D.260 Refusal of employer to produce document for audit; order to
compel; penalty for failure to comply with order.
1. If an employer refuses to produce any
book, record, payroll report or other document in conjunction with an audit
conducted by a private carrier or the Department of Taxation to verify the
employer’s premium, the Administrator may issue a subpoena to require the
production of that document.
2. If an employer refuses to produce any
document as required by the subpoena, the Administrator may report to the
district court by petition, setting forth that:
(a) Due notice has been given of the time and
place of the production of the document;
(b) The employer has been subpoenaed by the
Administrator pursuant to this section; and
(c) The employer has failed or refused to produce
the document required by the subpoena,
Ê and asking
for an order of the court compelling the employer to produce the document.
3. Upon such petition, the court shall
enter an order directing the employer to appear before the court at a time and
place to be fixed by the court in its order, the time to be not more than 10
days after the date of the order, and to show cause why the employer has not
produced the document. A certified copy of the order must be served upon the
employer.
4. If it appears to the court that the
subpoena was regularly issued by the Administrator, the court shall enter an
order that the employer produce the required document at the time and place
fixed in the order. Failure to obey the order constitutes contempt of court.
(Added to NRS by 1991, 2390; A 1993, 1873; 1997, 1444; 1999, 1800)
NRS 616D.270 Failure to post and maintain notices. Any
employer who fails:
1. To post the notice required by NRS 616A.490 and 616B.650 in a place that is readily
accessible and visible to employees is guilty of a misdemeanor.
2. To maintain the notice or notices
required by NRS 616A.490 and 616B.650 is guilty of a misdemeanor.
[Part 36:168:1947; 1943 NCL § 2680.36]—(NRS A 1991, 2429; 1995, 2034)
NRS 616D.290 Injury of minor unlawfully employed. If
any worker at the time of an injury is under the minimum age prescribed by law
for the employment of a minor in the occupation in which the worker is engaged
when injured, the employer is liable to the Division for a penalty of not less
than $300 nor more than $2,000, to be collected in a civil action at law by the
Division.
[Part 83:168:1947; A 1949, 659; 1943 NCL §
2680.83]—(NRS A 1981,
1499; 1993,
1876)—(Substituted in revision for NRS 616.670)
NRS 616D.300 False statements or representations to obtain benefits;
concealment of material fact to obtain benefits; penalty. Unless a different penalty is provided
pursuant to NRS 616D.370 to 616D.410, inclusive, a person who knowingly makes a
false statement or representation, including, but not limited to, a false
statement or representation relating to the person’s identity or the identity
of another person, or who knowingly conceals a material fact to obtain or
attempt to obtain any benefit, including a controlled substance, or payment
under the provisions of this chapter or chapter
616A, 616B, 616C or 617
of NRS, for himself, for herself or for any other person, shall be punished as
follows:
1. If the amount of the benefit or payment
obtained or attempted to be obtained was less than $250, for a misdemeanor.
2. If the amount of the benefit or payment
obtained or attempted to be obtained was $250 or more, for a category D felony
as provided in NRS 193.130.
Ê In addition
to any other penalty, the court shall order the person to pay restitution.
[73:168:1947; 1943 NCL § 2680.73]—(NRS A 1957, 29; 1983, 646; 1989, 1190; 1993, 759; 1995, 171, 1307, 1328, 1874; 1997, 569; 1999, 229)
NRS 616D.310 False statements or representations concerning employment of
person receiving benefits; penalty. A
person who knowingly makes a false statement or representation concerning the
employment of a person who is receiving benefits pursuant to chapters 616A to 616D,
inclusive, or chapter 617 of NRS is guilty of
a category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1991, 2391; A 1993, 760; 1995, 1309; 1999, 230)
NRS 616D.320 Employment of person who is receiving unlawful payments for
temporary total disability prohibited; penalty.
1. An employer shall not knowingly offer
employment or continue to employ a person who is receiving payments for a
temporary total disability in violation of the provisions of chapters 616A to 616D,
inclusive, or chapter 617 of NRS or NRS 281.390.
2. An employer who is convicted of
violating the provisions of subsection 1 is guilty of a gross misdemeanor.
(Added to NRS by 1995, 1872; A 1999, 230)
NRS 616D.330 Improper oral or written communications with treating physician
or chiropractor of injured employee; exceptions; penalty.
1. An insurer, an employer, an
organization for managed care, a third-party administrator or the
representative of any of those persons, the Nevada Attorney for Injured Workers
or an attorney or other compensated representative of an injured employee shall
not initiate:
(a) Any oral communication relating to the
medical disposition of the claim of an injured employee with the injured
employee’s examining or treating physician or chiropractor unless the initiator
of the oral communication:
(1) Maintains, in written form or in a
form from which a written record may be produced, a log that includes the date,
time and subject matter of the communication; and
(2) Makes the log available, upon request,
to each insurer, organization for managed care and third-party administrator
interested in the claim or the representative of each of those persons, the
Administrator and the injured employee, the injured employee’s representative
and the injured employee’s employer; or
(b) Any written communication relating to the
medical disposition of the claim with the injured employee’s examining or
treating physician or chiropractor unless a copy of the communication is
submitted to the injured employee or the injured employee’s representative in a
timely manner.
2. If the Administrator determines that a
person has violated the provisions of this section, the Administrator shall:
(a) For an initial violation, issue a notice of
correction.
(b) For a second violation, impose an
administrative fine of not more than $250.
(c) For a third or subsequent violation, impose
an administrative fine of not more than $1,000.
(Added to NRS by 1997, 1789)
FRAUDULENT PRACTICES
NRS 616D.350 Definitions. As
used in NRS 616D.350 to 616D.440,
inclusive, unless the context otherwise requires:
1. “Charge” means any communication, whether
oral, written, electronic or magnetic, which is used to identify specific
accident benefits as reimbursable pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS, or which may be used to determine a
rate of payment pursuant to those chapters.
2. “Provider of health care” means a
person who receives or attempts to receive payment from:
(a) An insurer;
(b) A third-party administrator; or
(c) An organization for managed care which has
contracted with an insurer or third-party administrator,
Ê for accident
benefits provided or alleged to have been provided to an injured employee
pursuant to the provisions of chapters 616A
to 616D, inclusive, or chapter 617 of NRS.
3. “Record” means any medical,
professional or business record relating to:
(a) The treatment or care of an injured employee;
(b) Accident benefits provided to an injured
employee; or
(c) Rates paid for such accident benefits.
(Added to NRS by 1993, 680; A 1995, 531, 1875)—(Substituted
in revision for NRS 616.676)
NRS 616D.360 Circumstances under which person is deemed to have knowledge of
falsity or deemed to have made or caused certain action. For the purposes of NRS
616D.370 and 616D.380:
1. A person shall be deemed to know that a
charge, statement or representation is false if the person knows, or by virtue
of the person’s position, authority or responsibility has reason to know, of
the falsity of the charge, statement or representation.
2. A person shall be deemed to have made
or caused to be made a charge, statement or representation if the person:
(a) Had the authority or responsibility to:
(1) Make the charge, statement or representation;
(2) Supervise another person who made the
charge, statement or representation; or
(3) Authorize the making of the charge,
statement or representation,
Ê whether by
operation of law, business or professional practice or office procedure; and
(b) Exercised that authority or responsibility or
failed to exercise that authority or responsibility and, as a direct or
indirect result, the charge, statement or representation was made.
(Added to NRS by 1993, 681)—(Substituted
in revision for NRS 616.677)
NRS 616D.370 False charges, representations and statements; penalty.
1. A person shall not, by any act or omission:
(a) Make a charge or cause it to be made knowing
the charge to be false, in whole or in part;
(b) Make or cause to be made a statement or
representation for use in obtaining or seeking to obtain authorization to
provide specific accident benefits pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS, knowing the statement or
representation to be false, in whole or in part; or
(c) Make or cause to be made a statement or
representation for use by another person to obtain accident benefits pursuant
to chapters 616A to 616D,
inclusive, or chapter 617 of NRS, knowing the
statement or representation to be false, in whole or in part.
2. A person who violates any of the
provisions of this section shall be punished:
(a) If the amount of the charge or the value of
the accident benefits obtained or sought to be obtained was $650 or more, for a
category D felony as provided in NRS
193.130. In addition to any other penalty, the court shall order the person
to pay restitution.
(b) If the amount of the charge or the value of
the accident benefits obtained or sought to be obtained was less than $650, for
a misdemeanor, and must be sentenced to restore any accident benefits so
obtained, if it can be done, or tender payment for rent or labor.
(Added to NRS by 1993, 681; A 1995, 1308; 2011, 178)
NRS 616D.380 Invoices containing false information; signature required;
presumption.
1. Each invoice for payment for accident
benefits provided to an injured employee must:
(a) Contain a statement that all matters stated
therein are true and accurate; and
(b) Be signed by a natural person who is the
provider of health care or is authorized to act for the provider of health
care.
2. A person who, by any act or omission,
signs or submits, or causes to be signed or submitted, the statement required
by subsection 1, knowing that the invoice contains information which is false,
in whole or in part, is guilty of a gross misdemeanor.
3. For the purposes of this section, a
person who signs on behalf of a provider of health care is presumed to have the
authorization of the provider of health care and to be acting at the direction
of the provider of health care.
4. As used in this section, to “sign”
means to affix a signature directly or indirectly by means of handwriting, a
typewriter, a stamp, a computer impulse or other means.
(Added to NRS by 1993, 681)—(Substituted
in revision for NRS 616.679)
NRS 616D.390 Certain acts relating to offer, payment, transfer, acceptance or
solicitation of additional value prohibited; improper use of referral fees;
exceptions; penalty.
1. Except as otherwise provided in
subsection 2, a person shall not:
(a) While acting on behalf of a provider of
health care, purchase or lease goods, services, materials or supplies for which
payment may be made, in whole or in part, pursuant to chapters 616A to 616D,
inclusive, or chapter 617 of NRS, and solicit
or accept anything of additional value in return for or in connection with the
purchase or lease;
(b) Sell or lease to or for the use of a provider
of health care goods, services, materials or supplies for which payment may be
made, in whole or in part, pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS, and offer, transfer or pay anything
of additional value in connection with or in return for the sale or lease; or
(c) Refer a person to a provider of health care
for accident benefits for which payment may be made, in whole or in part,
pursuant to chapters 616A to 616D, inclusive, or chapter 617
of NRS, and solicit or accept anything of value in connection with the
referral.
2. Paragraphs (a) and (b) of subsection 1
do not apply if the additional value transferred is:
(a) A refund or discount made in the ordinary
course of business;
(b) Reflected by the books and records of the
person transferring or receiving it; and
(c) Reflected in the charges submitted to the
insurer.
3. A provider of health care shall not
offer, transfer or pay anything of value in connection with or in return for
the referral to the provider of a patient for whom payment of accident benefits
may be made, in whole or in part, pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS.
4. A person shall not, while acting on
behalf of a provider of health care pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS, charge, solicit, accept or receive
anything of value in addition to the amount legally payable pursuant to any of
those chapters in connection with the provision of the accident benefits.
5. A person who violates any provision of
this section, if the value of the thing or any combination of things unlawfully
solicited, accepted, offered, transferred, paid, charged or received:
(a) Is less than $650, is guilty of a gross
misdemeanor.
(b) Is $650 or more, is guilty of a category D
felony and shall be punished as provided in NRS
193.130.
(Added to NRS by 1993, 682; A 1995, 1308; 1997, 3223; 2011, 178)
NRS 616D.400 Failure to maintain and make available necessary records;
penalty.
1. A person who, upon submitting a charge
for or upon receiving payment for accident benefits pursuant to chapters 616A to 616D,
inclusive, or chapter 617 of NRS,
intentionally fails to maintain such records as are necessary to disclose fully
the nature of the accident benefits for which a charge was submitted or payment
was received, or such records as are necessary to disclose fully all income and
expenditures upon which rates of payment were based, for at least 5 years after
the date on which payment was received, is guilty of a gross misdemeanor.
2. A person who fails to make such records
available to the Attorney General or the Administrator upon reasonable request
is guilty of a gross misdemeanor.
3. A person who intentionally destroys
such records within 5 years after the date payment was received is guilty of a
category D felony and shall be punished as provided in NRS 193.130.
(Added to NRS by 1993, 682; A 1995, 1309; 1999, 1801)
NRS 616D.410 Conspiracy to commit prohibited acts. Any
person who conspires with any other person to violate:
1. Any of the provisions of NRS 616D.200 is guilty of a misdemeanor.
2. Any of the provisions of NRS 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440,
inclusive, is guilty of a gross misdemeanor.
(Added to NRS by 1993, 684; A 1997, 3224)
NRS 616D.415 Fraud; conspiracy to commit fraud; penalty.
1. An employer who knowingly makes a false
statement or representation or knowingly conceals a material fact regarding the
eligibility of a person claiming benefits under this chapter or chapter 616A, 616B,
616C or 617
of NRS, including, without limitation, information relating to:
(a) The identity of the person; or
(b) The classification of the person as an
independent contractor,
Ê commits
fraud in the administration of this chapter or chapter
616A, 616B, 616C or 617
of NRS or in the provision of compensation required by chapters 616A to 617,
inclusive, of NRS, as applicable.
2. An employer who commits fraud as
described in subsection 1 shall be punished as follows:
(a) If the amount of the benefit or payment
obtained or attempted to be obtained was less than $250, for a misdemeanor.
(b) If the amount of the benefit or payment
obtained or attempted to be obtained was $250 or more, for a category D felony
as provided in NRS 193.130.
3. Any person who conspires with any other
person to commit fraud in the administration of this chapter or chapter 616A, 616B,
616C or 617
of NRS or in the provision of compensation required by chapters 616A to 617,
inclusive, of NRS as described in subsection 1 shall be punished as follows:
(a) If the amount of the benefit or payment
obtained or attempted to be obtained was less than $250, for a misdemeanor.
(b) If the amount of the benefit or payment
obtained or attempted to be obtained was $250 or more, for a category D felony
as provided in NRS 193.130.
(Added to NRS by 2011, 841)
NRS 616D.420 Provider of health care convicted of fraudulent practice
prohibited from receiving or accepting payment for accident benefits; penalty.
1. No provider of health care who has been
convicted of violating any provision of NRS 616D.370
to 616D.410, inclusive, may, for 5 years after the
date of the first conviction or at any time after the date of a second or
subsequent conviction, receive or accept a payment for accident benefits
provided or alleged to have been provided to an injured employee pursuant to
the provisions of chapters 616A to 616D, inclusive, or chapter 617
of NRS.
2. A person who violates any provision of
this section is guilty of a gross misdemeanor.
(Added to NRS by 1995, 1872)
NRS 616D.430 Civil penalties for person who receives payment or benefit to
which person is not entitled.
1. A person who receives a payment or
benefit to which the person is not entitled by reason of a violation of any of
the provisions of NRS 616D.300, 616D.370, 616D.380, 616D.390, 616D.400 or 616D.410 is liable in a civil action commenced by the
Attorney General for:
(a) An amount equal to three times the amount
unlawfully obtained;
(b) Not less than $5,000 for each act of
deception;
(c) An amount equal to three times the total
amount of the reasonable expenses incurred by the State in enforcing this
section; and
(d) Payment of interest on the amount of the
excess payment at the rate fixed pursuant to NRS
99.040 for the period from the date upon which payment was made to the date
upon which repayment is made.
2. A criminal action need not be brought
against a person who receives a payment or benefit to which the person is not
entitled by reason of a violation of any of the provisions of NRS 616D.300, 616D.370, 616D.380, 616D.390, 616D.400 or 616D.410
before civil liability attaches under this section.
3. A person who unknowingly accepts a
payment in excess of the amount to which the person is entitled is liable for
the repayment of the excess amount. It is a defense to any action brought
pursuant to this subsection that the person returned or attempted to return the
amount which was in excess of that to which the person was entitled within a
reasonable time after receiving it.
4. Any repayment of money collected
pursuant to paragraph (a) or (d) of subsection 1 must be paid to the insurer
who made the payment to the person who violated the provisions of this section.
Any payment made to an insurer may not exceed the amount paid by the insurer to
that person.
5. Any penalty collected pursuant to
paragraph (b) or (c) of subsection 1 must be used to pay the salaries and other
expenses of the Fraud Control Unit for Industrial Insurance established
pursuant to NRS 228.420. Any money
remaining at the end of any fiscal year does not revert to the State General Fund.
(Added to NRS by 1993, 683; A 1995, 1875; 1999, 1801)
NRS 616D.440 False claim for payment: Withholding by insurer of payment to
provider of health care; procedure for withholding; appeal.
1. An insurer may withhold any payment due
a provider of health care pursuant to the provisions of chapters 616A to 616D,
inclusive, or chapter 617 of NRS, in whole or
in part, upon receipt of reliable evidence that the provider of health care
knowingly made a false statement or representation or knowingly concealed a
material fact to obtain the payment. The insurer may withhold such a payment
without first notifying the provider of health care of its intention to do so.
2. The insurer shall, within 5 days after
withholding such a payment, send notice of the withholding to the provider of
health care by certified mail or electronic transmission. The notice must:
(a) Set forth the factual basis for the
withholding, but need not disclose specific information regarding the insurer’s
investigation;
(b) Indicate that the payment is being withheld
pursuant to the provisions of this section;
(c) Indicate that the payment is being withheld
temporarily, as set forth in subsection 4, and describe the circumstances under
which the withholding will be terminated;
(d) Specify the charge submitted by the provider
of health care for which the payment is being withheld; and
(e) Notify the provider of health care of the
right of the provider of health care to appeal the withholding.
3. A provider of health care may appeal
the decision of the insurer to withhold payment to an appeals officer pursuant
to NRS 616C.360.
4. Any payment withheld pursuant to the
provisions of this section must be made to the provider of health care if:
(a) The insurer or the Attorney General
determines that there is insufficient evidence to prove that the provider of
health care knowingly made a false statement or representation or knowingly
concealed a material fact to obtain the payment; or
(b) A final judgment or decree was rendered in
favor of the provider of health care in a criminal proceeding arising out of
the alleged misconduct.
(Added to NRS by 1993, 683; A 1997, 1444)
REPORTING VIOLATIONS
NRS 616D.550 Duty to report violations to Fraud Control Unit for Industrial
Insurance.
1. An insurer, organization for
managed care, health care provider, employer, third-party administrator or
public officer who believes, or has reason to believe, that:
(a) A fraudulent claim for benefits under a
policy of insurance has been made, or is about to be made;
(b) An employer within the provisions of NRS 616B.633 has:
(1) Knowingly made a false statement or
representation concerning the amount of payroll upon which a premium is based;
or
(2) Failed to provide and secure
compensation under the terms of chapters 616A
to 616D, inclusive, or chapter 617 of NRS or has failed to maintain that
compensation;
(c) A provider of health care has submitted an
invoice for payment for accident benefits that contains information which the
provider knows is false; or
(d) A person has committed any other fraudulent
practice under this chapter or chapter 616A,
616B, 616C
or 617 of NRS,
Ê shall report
that belief to the Fraud Control Unit for Industrial Insurance established
pursuant to NRS 228.420.
2. The Fraud Control Unit for Industrial
Insurance established pursuant to NRS
228.420 may require a person who submits a report pursuant to subsection 1
to submit that report on a form prescribed by the Unit.
(Added to NRS by 1997, 3218; A 1999, 230)
NRS 616D.560 Duty of Administrator and Fraud Control Unit for Industrial
Insurance to report and share information relating to violations. The Administrator and the Fraud Control Unit
for Industrial Insurance established pursuant to NRS 228.420 shall establish procedures to
ensure that:
1. The Administrator, in accordance with
the established procedures, reports to the Unit violations of the provisions of
NRS 616D.200, 616D.220,
616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440, inclusive, of which the Administrator
becomes aware;
2. For the purposes of NRS 616D.120, the Unit notifies the Administrator in
a timely manner whether the Unit will prosecute a person who has violated the
provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440,
inclusive; and
3. The Administrator and the Unit share
other information of which they are aware relating to violations of the
provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440,
inclusive.
(Added to NRS by 1997, 3219; A 2011, 842)
PROSECUTION
NRS 616D.600 Prosecution of criminal actions by Attorney General: Prosecution
not precluded by commencement of civil action; duty to furnish information to
assist in prosecution; penalty.
1. The Attorney General may prosecute all
criminal actions for the violation of any of the provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440, inclusive. The commencement of a civil
action by the Attorney General pursuant to NRS
616D.230 or 616D.430 or for the recovery of
any civil penalties, fines, fees or assessments imposed pursuant to the
provisions of chapters 616A to 616D, inclusive, or chapter 617
of NRS does not preclude the prosecution of a criminal action by the Attorney
General pursuant to this section.
2. Upon request, any person shall furnish
to the Attorney General information which would assist in the prosecution of
any person alleged to have violated any of the provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440, inclusive. Any person who fails to furnish
such information upon request is guilty of a misdemeanor.
(Added to NRS by 1993, 684; A 1995, 1876; 2011, 842)
NRS 616D.610 Inspection of employer’s books, records and payroll by Attorney
General; subpoena; court order; penalty.
1. The books, records and payrolls of an
employer pertinent to the investigation of a violation of any of the provisions
of NRS 616D.200, 616D.220,
616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440, inclusive, or any fraud in the
administration of this chapter or chapter 616A,
616B, 616C
or 617 of NRS or in the provision of benefits
for industrial insurance, must always be open to inspection by an investigator
for the Attorney General for the purpose of ascertaining the correctness of
such information and as may be necessary for the Attorney General to carry out
his or her duties pursuant to NRS 228.420.
If the books, records or payrolls are located outside this State, the employer
shall make any records requested pursuant to this section available in this
State for inspection within 10 working days after the request.
2. If an employer refuses to produce any
book, record, payroll report or other document in conjunction with an
investigation conducted by the Fraud Control Unit for Industrial Insurance, the
Attorney General may issue a subpoena to require the production of that
document.
3. If an employer refuses to produce any
document as required by the subpoena, the Attorney General may report to the
district court by petition, setting forth that:
(a) Due notice has been given of the time and
place of the production of the document;
(b) The employer has been subpoenaed by the
Attorney General pursuant to this section; and
(c) The employer has failed or refused to produce
the document required by the subpoena,
Ê and asking
for an order of the court compelling the employer to produce the document.
4. Upon such petition, the court shall
enter an order directing the employer to appear before the court at a time and
place to be fixed by the court in its order, the time to be not more than 10
days after the date of the order, and to show cause why the employer has not
produced the document. A certified copy of the order must be served upon the
employer.
5. If it appears to the court that the
subpoena was regularly issued by the Attorney General, the court shall enter an
order that the employer produce the required document at the time and place
fixed in the order. Failure to obey the order constitutes contempt of court.
(Added to NRS by 1993, 684; A 1995, 1876; 2011, 843)
NRS 616D.620 Penalty for certain violations; liability for costs of
investigation and prosecution; contents of judgment of conviction; receipt of
certain money by Attorney General to be used to pay salaries of Fraud Control
Unit for Industrial Insurance.
1. If a person is convicted of violating
any of the provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310 or 616D.350 to 616D.440,
inclusive, the person:
(a) Forfeits all rights to compensation under chapters 616A to 616D,
inclusive, or chapter 617 of NRS after
conviction for the offense; and
(b) Is liable for:
(1) The reasonable costs incurred by an
insurer and the office of the Attorney General to investigate and act upon the
violation;
(2) All costs incurred for the prosecution
of the person by the court in which the conviction was obtained; and
(3) The payments or benefits fraudulently
obtained under chapters 616A to 616D, inclusive, or chapter 617
of NRS.
2. A judgment of conviction entered
against the person must contain a provision which requires the person convicted
to pay the costs of investigation and prosecution and the payments or benefits
specified in subsection 1.
3. Any money received by the Attorney
General pursuant to subparagraph (1) of paragraph (b) of subsection 1 must be
used to pay the salaries and other expenses of the Fraud Control Unit for
Industrial Insurance established pursuant to NRS
228.420. Any money remaining at the end of any fiscal year does not revert
to the State General Fund.
(Added to NRS by 1993, 685; A 1993, 2450; 1995, 1877; 2011, 843)