Nrs: Chapter 616D - Industrial Insurance: Prohibited Acts; Penalties; Prosecution

Link to law: https://www.leg.state.nv.us/NRS/NRS-616D.html
Published: 2015

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[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)