2005 Nevada Revised Statutes - Chapter 616D — Industrial Insurance: Prohibited Acts; Penalties; Prosecution
CHAPTER 616D - INDUSTRIAL INSURANCE:PROHIBITED ACTS; PENALTIES; PROSECUTION
GENERAL PROVISIONS
NRS 616D.010 Penaltiesand remedies are cumulative; exceptions.
NRS 616D.020 Immunityfrom criminal penalty or civil action for libel, slander or similar tort fordisclosure of information relating to violation.
NRS 616D.030 Limitationof liability of insurer or third-party administrator; administrative fines areexclusive remedies.
ADMINISTRATIVE PROCEEDINGS
NRS 616D.050 Powerof hearing officers, appeals officers and Administrator when conductinghearings or other proceedings.
NRS 616D.060 Disciplinaryaction by hearing officer or panel: Procedural requirements; powers and dutiesof officer or panel; appeals.
NRS 616D.065 Disciplinaryaction by appeals officer: Order requiring attorney or representative of partyto pay certain costs incurred because of continuance or delay in scheduledhearing.
NRS 616D.070 Enforcementof orders, subpoenas and other procedures relating to hearing.
NRS 616D.080 Fees:Officers serving subpoenas; witnesses; procedure for payment.
NRS 616D.090 Depositionsof witnesses.
NRS 616D.100 Transcripts:Introduction in evidence; availability to parties.
NRS 616D.110 Orderto cease business operations if employer fails to provide or maintain coveragefor industrial insurance: Power of Administrator; contents; procedure;assistance from law enforcement agency.
NRS 616D.115 Failureto comply with order to cease business operations; penalties; cumulative natureof penalties.
NRS 616D.120 Administrativefines and benefit penalties for certain violations; powers of Administrator;revocation or withdrawal of certificate of self-insurance or registration asthird-party administrator.
NRS 616D.130 Investigationof alleged violation; determination of Administrator.
NRS 616D.140 Benefitpenalties: Appeal of imposition of penalty or determination made byAdministrator; finality of imposition of penalty; payment of penalty; recoveryby Administrator of unpaid penalty.
NRS 616D.145 Administrativefines: Appeal of imposition of fine; finality of imposition of fine; payment offine; recovery by Division of unpaid fine.
NRS 616D.150 Appealof decisions of Administrator.
PROHIBITED ACTS
NRS 616D.200 Failureof employer to provide, secure and maintain compensation: Procedure fordetermination and appeal; penalty.
NRS 616D.210 Engagementin new business after termination of prior business while owing premiums,interest or penalties to private carriers: Prohibitions; penalties.
NRS 616D.220 Liabilityfor false statement or failure to report material fact concerning amount ofpayroll or misrepresentation of classification or duties of employee; appeal;penalty.
NRS 616D.230 Failureof employer to pay amount charged to him for engaging in certain prohibitedacts; civil liability; additional penalties; disposition of amount collected.
NRS 616D.240 Deductionfrom wages of employee prohibited; requirement by employer that employeeprovide compensation on his own behalf prohibited; enforcement of prohibitedacts by Attorney General.
NRS 616D.250 Refusalof employer to submit records for inspection; penalty.
NRS 616D.260 Refusalof employer to produce document for audit; order to compel; penalty for failureto comply with order.
NRS 616D.270 Failureto post and maintain notices.
NRS 616D.290 Injuryof minor unlawfully employed.
NRS 616D.300 Falsestatements or representations to obtain benefits; concealment of material factto obtain benefits; penalty.
NRS 616D.310 Falsestatements or representations concerning employment of person receivingbenefits; penalty.
NRS 616D.320 Employmentof person who is receiving unlawful payments for temporary total disabilityprohibited; penalty.
NRS 616D.330 Improperoral or written communications with treating physician or chiropractor ofinjured employee; exceptions; penalty.
FRAUDULENT PRACTICES
NRS 616D.350 Definitions.
NRS 616D.360 Circumstancesunder which person is deemed to have knowledge of falsity or deemed to havemade or caused certain action.
NRS 616D.370 Falsecharges, representations and statements; penalty.
NRS 616D.380 Invoicescontaining false information; signature required; presumption.
NRS 616D.390 Certainacts relating to offer, payment, transfer, acceptance or solicitation ofadditional value prohibited; improper use of referral fees; exceptions;penalty.
NRS 616D.400 Failureto maintain and make available necessary records; penalty.
NRS 616D.410 Conspiracyto commit prohibited acts.
NRS 616D.420 Providerof health care convicted of fraudulent practice prohibited from receiving oraccepting payment for accident benefits; penalty.
NRS 616D.430 Civilpenalties for person who receives payment or benefit to which he is notentitled.
NRS 616D.440 Falseclaim for payment: Withholding by insurer of payment to provider of healthcare; procedure for withholding; appeal.
REPORTING VIOLATIONS
NRS 616D.550 Dutyto report violations to Fraud Control Unit for Industrial Insurance.
NRS 616D.560 Dutyof Administrator and Fraud Control Unit for Industrial Insurance to report andshare information relating to violations.
PROSECUTION
NRS 616D.600 Prosecutionof criminal actions by Attorney General: Prosecution not precluded bycommencement of civil action; duty to furnish information to assist inprosecution; penalty.
NRS 616D.610 Inspectionof employers books, records and payroll by Attorney General; subpoena; courtorder; penalty.
NRS 616D.620 Penaltyfor certain violations; liability for costs of investigation and prosecution;contents of judgment of conviction; receipt of certain money by AttorneyGeneral to be used to pay salaries of Fraud Control Unit for IndustrialInsurance.
_________
GENERAL PROVISIONS
NRS
(Added to NRS by 1993, 685)(Substituted in revisionfor NRS 616.740)
NRS
(Added to NRS by 1993, 685)(Substituted in revisionfor NRS 616.750)
NRS
1. No cause of action may be brought or maintainedagainst an insurer or a third-party administrator who violates any provision ofthis chapter or chapter 616A,
2. The administrative fines provided for in
(Added to NRS by 1995, 2122)
ADMINISTRATIVE PROCEEDINGS
NRS
1. Appeals officers, the Administrator, and theAdministrators designee, in conducting hearings or other proceedings pursuantto the provisions of chapters 616A to
(a) Issue subpoenas requiring the attendance of anywitness 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 toa claim.
(e) Maintain order.
(f) Rule upon all questions arising during the courseof a hearing or proceeding.
(g) Permit discovery by deposition or interrogatories.
(h) Initiate and hold conferences for the settlement orsimplification of issues.
(i) Dispose of procedural requests or similar matters.
(j) Generally regulate and guide the course of apending hearing or proceeding.
2. Hearing officers, in conducting hearings or otherproceedings pursuant to the provisions of chapters616A to 616D, inclusive, or
(a) Issue subpoenas requiring the attendance of anywitness or the production of books, accounts, papers, records and documentsthat are relevant to the dispute for which the hearing or other proceeding isbeing held.
(b) Maintain order.
(c) Permit discovery by deposition or interrogatories.
(d) Initiate and hold conferences for the settlement orsimplification of issues.
(e) Dispose of procedural requests or similar matters.
(f) Generally regulate and guide the course of apending hearing or proceeding.
(Added to NRS by 1975, 761; A 1977, 313; 1979, 1044;1981, 1139, 1461; 1983, 355; 1991, 832, 2402; 1993, 708;
NRS
1. Any disciplinary action taken by a hearing officeror panel pursuant to NRS 616A.467 issubject to the same procedural requirements which apply to disciplinary actionstaken by the Commissioner or Administrator, and the board or panel has the samepowers and duties given to the Commissioner or Administrator in relationthereto.
2. A decision of the hearing officer or panel relatingto the imposition of an administrative fine is a final decision in a contestedcase. Any party aggrieved by a decision of the officer or panel to withdraw thecertification of a self-insured employer or an association of self-insuredpublic or private employers or the authorization of a private carrier mayappeal that decision to the Commissioner.
(Added to NRS by 1983, 1532; A 1993, 709; 1995, 2014)
NRS
1. An appeals officer, in conducting hearings or otherproceedings pursuant to the provisions of chapters616A to 616D, inclusive, or
2. Before ordering the payment of such costs, theappeals officer must find that the costs were incurred because the attorney orrepresentative of a party caused a continuance or delay in a scheduled hearingby his failure, without good cause, to comply with an order of the appealsofficer or a regulation adopted pursuant to chapters616A to 616D, inclusive, or
(Added to NRS by 1997, 3091; A
NRS
1. Disobeys an order of an appeals officer, a hearingofficer, the Administrator or the Administrators designee, or a subpoenaissued by the Administrator, Administrators designee, appeals officer, hearingofficer, inspector or examiner;
2. Refuses to permit an inspection; or
3. As a witness, refuses to testify to any matter forwhich he may be lawfully interrogated,
the districtjudge of the county in which the person resides, on application of the appealsofficer, the hearing officer, the Administrator or the Administrators designee,shall compel obedience by attachment proceedings as for contempt, as in thecase of disobedience of the requirements of subpoenas issued from the court ona 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;
NRS
1. Each officer who serves a subpoena is entitled toreceive the same fees as a sheriff.
2. Each witness who appears, in obedience to a subpoenawhich has been issued pursuant to this chapter or chapter616A, 616B,
3. The appeals officer, hearing officer, Administratoror the Administrators designee shall:
(a) Authorize payment from his administrative budget ofthe fees and mileage due to such a witness; or
(b) Impose those costs upon the party at whose instancethe 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;
NRS
1. In an investigation, the Administrator or a hearingofficer may cause depositions of witnesses residing within or without the Stateto be taken in the manner prescribed by law and Nevada Rules of Civil Procedurefor taking depositions in civil actions in courts of record.
2. After the initiation of a claim under theprovisions of this chapter or chapter 616A,
(a) Serve upon any other party written interrogatoriesto be answered by the party served; or
(b) Take the testimony of any person, including aparty, 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
1. A transcribed copy of the evidence and proceedings,or any specific part thereof, of any final hearing or investigation, made by astenographer appointed by an appeals officer, a hearing officer, theAdministrator or the Administrators designee, being certified by thatstenographer to be a true and correct transcript of the testimony in the finalhearing or investigation, or of a particular witness, or of a specific partthereof, and carefully compared by him with his original notes, and to be a correctstatement of the evidence and proceedings had on the final hearing or investigationso purporting to be taken and transcribed, may be received in evidence with thesame effect as if the stenographer had been present and testified to the factsso certified.
2. A copy of the transcript must be furnished ondemand to any party upon the payment of the fee required for transcripts incourts 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;
NRS
1. In addition to any other remedy provided for bylaw, if any employer within the provisions of
2. The order must:
(a) Include a reference to the particular sections ofthe statutes or regulations alleged to have been violated, and a short, plainstatement of the facts alleged to constitute the violation.
(b) Provide an opportunity for hearing to the employeron a date fixed in the order which must not be less than 5 nor more than 15days after the date of the order, unless upon demand of the employer the dateis advanced to the next business day after the demand is made to theAdministrator.
An order forsummary suspension issued pursuant to this subsection must be endorsed with thedate and hour of issuance and entered of record in the office of theAdministrator.
3. Immediately upon receiving an order to ceasebusiness operations under subsection 1, an employer shall order all employeesor other persons to leave the place of employment or jobsite and shall ceaseall business operations thereat.
4. Upon request by the Administrator, any lawenforcement agency in this State shall render any assistance necessary to carryout the requirement of subsection 3, including but not limited to preventingany employee or other person from remaining at the place of employment orjobsite.
(Added to NRS by 1973, 585; A 1981, 1497;
NRS
1. A person shall not knowingly fail to comply with anorder issued by the Administrator pursuant to
2. A person who is convicted of violating theprovisions of subsection 1 is guilty of a misdemeanor.
3. A criminal penalty imposed pursuant to this sectionis in addition to any civil penalty or other remedy available pursuant toanother statute.
(Added to NRS by
NRS
1. Except as otherwise provided in this section, ifthe Administrator determines that an insurer, organization for managed care,health care provider, third-party administrator or employer has:
(a) Induced a claimant to fail to report an accidentalinjury or occupational disease;
(b) Without justification, persuaded a claimant to:
(1) Settle for an amount which is less thanreasonable;
(2) Settle for an amount which is less thanreasonable while a hearing or an appeal is pending; or
(3) Accept less than the compensation found tobe due him by a hearing officer, appeals officer, court of competentjurisdiction, written settlement agreement, written stipulation or the Divisionwhen carrying out its duties pursuant to chapters616A to 617, inclusive, of NRS;
(c) Refused to pay or unreasonably delayed payment to aclaimant of compensation or other relief found to be due him by a hearingofficer, appeals officer, court of competent jurisdiction, written settlementagreement, written stipulation or the Division when carrying out its dutiespursuant to chapters 616A to
(1) Later than 10 days after the date of thesettlement agreement or stipulation;
(2) Later than 30 days after the date of thedecision of a court, hearing officer, appeals officer or the Division, unless astay has been granted; or
(3) Later than 10 days after a stay of thedecision of a court, hearing officer, appeals officer or the Division has beenlifted;
(d) Refused to process a claim for compensationpursuant to chapters 616A to
(e) Made it necessary for a claimant to initiateproceedings pursuant to chapters 616A to
(f) Failed to comply with the Divisions regulationscovering the payment of an assessment relating to the funding of costs ofadministration of chapters 616A to
(g) Failed to provide or unreasonably delayed paymentto an injured employee or reimbursement to an insurer pursuant to
(h) Intentionally failed to comply with any provisionof, or regulation adopted pursuant to, this chapter or
theAdministrator shall impose an administrative fine of $1,500 for each initialviolation, or a fine of $15,000 for a second or subsequent violation.
2. Except as otherwise provided in
(a) Issue a notice of correction for:
(1) A minor violation, as defined by regulationsadopted by the Division; or
(2) A violation involving the payment of compensationin an amount which is greater than that required by any provision of thischapter or chapter 616A,
The noticeof correction must set forth with particularity the violation committed and themanner in which the violation may be corrected. The provisions of this sectiondo not authorize the Administrator to modify or negate in any manner a determinationor any portion of a determination made by a hearing officer, appeals officer orcourt of competent jurisdiction or a provision contained in a writtensettlement agreement or written stipulation.
(b) Impose an administrative fine for:
(1) A second or subsequent violation for which anotice of correction has been issued pursuant to paragraph (a); or
(2) Any other violation of this chapter or
The fineimposed must not be greater than $375 for an initial violation, or more than$1,500 for any second or subsequent violation.
(c) Order a plan of corrective action to be submittedto the Administrator within 30 days after the date of the order.
3. If the Administrator determines that a violation ofany of the provisions of paragraphs (a) to (e), inclusive, or (h) of subsection1 has occurred, the Administrator shall order the insurer, organization formanaged care, health care provider, third-party administrator or employer topay to the claimant a benefit penalty in an amount that is not less than $5,000and not greater than $37,500. To determine the amount of the benefit penalty,the Administrator shall consider the degree of physical harm suffered by theinjured employee or his dependents as a result of the violation of paragraph(a), (b), (c), (d), (e) or (h) of subsection 1, the amount of compensationfound to be due the claimant and the number of fines and benefit penaltiespreviously imposed against the insurer, organization for managed care, healthcare provider, third-party administrator or employer pursuant to this section.If this is the third violation within 5 years for which a benefit penalty hasbeen imposed against the insurer, organization for managed care, health careprovider, third-party administrator or employer, the Administrator shall alsoconsider the degree of economic harm suffered by the injured employee or hisdependents as a result of the violation of paragraph (a), (b), (c), (d), (e) or(h) of subsection 1. Except as otherwise provided in this section, the benefitpenalty is for the benefit of the claimant and must be paid directly to himwithin 10 days after the date of the Administrators determination. If theclaimant is the injured employee and he dies before the benefit penalty is paidto him, the benefit penalty must be paid to his estate. Proof of the payment ofthe benefit penalty must be submitted to the Administrator within 10 days afterthe date of his determination unless an appeal is filed pursuant to
4. In addition to any fine or benefit penalty imposedpursuant to this section, the Administrator may assess against an insurer whoviolates any regulation concerning the reporting of claims expenditures orpremiums received that are used to calculate an assessment, an administrativepenalty of up to twice the amount of any underpaid assessment.
5. If:
(a) The Administrator determines that a personhas violated any of the provisions of NRS616D.200, 616D.220,
(b) The Fraud Control Unit for Industrial Insurance ofthe Office of the Attorney General established pursuant to
theAdministrator shall impose an administrative fine of not more than $15,000.
6. Two or more fines of $1,000 or more imposed in 1year for acts enumerated in subsection 1 must be considered by the Commissioneras evidence for the withdrawal of:
(a) A certificate to act as a self-insured employer.
(b) A certificate to act as an association ofself-insured public or private employers.
(c) A certificate of registration as a third-partyadministrator.
7. The Commissioner may, without complying with theprovisions of NRS 616B.327 or
(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;
NRS
1. Upon receipt of a complaint for a violation ofsubsection 1 of NRS 616D.120, or ifthe Administrator has reason to believe that such a violation has occurred, theAdministrator shall cause to be conducted an investigation of the allegedviolation. Except as otherwise provided in subsection 2, the Administratorshall, within 30 days after initiating the investigation:
(a) Render a determination. The determination mustinclude his findings of fact and, if he determines that a violation hasoccurred, one or more of the following:
(1) The amount of any fine required to be paidpursuant to NRS 616D.120.
(2) The amount of any benefit penalty requiredto be paid to a claimant pursuant to NRS616D.120.
(3) A plan of corrective action to be taken bythe insurer, organization for managed care, health care provider, third-partyadministrator or employer, including the manner and time within which theviolation must be corrected.
(4) A requirement that notice of the violationbe given to the appropriate agency that regulates the activities of theviolator.
(b) Notify the Commissioner if he determines that aviolation was committed by a self-insured employer, association of self-insuredpublic or private employers or third-party administrator.
2. Upon receipt of a complaint for any violation ofparagraph (a), (b), (c) or (d) of subsection 1 of
3. If, based upon the Administrators findings offact, he determines that a violation has not occurred, he shall issue adetermination to that effect.
(Added to NRS by 1995, 1637; A
NRS
1. If a person wishes to contest a decision of theAdministrator to impose or refuse to impose a benefit penalty pursuant to
2. A personwho is aggrieved by:
(a) A writtendetermination of the Administrator; or
(b) The failureof the Administrator to respond within 90 days to a written request mailed tothe Administrator by the person who is aggrieved,
may appealfrom the determination or failure to respond by filing a request for a hearingbefore an appeals officer. The request must be filed within 30 days after thedate on which the notice of the Administrators determination was mailed by theAdministrator or within 100 days after the date on which the unanswered writtenrequest was mailed to the Administrator, as applicable. The failure of theAdministrator to respond to a written request for a determination within 90days after receipt of the request shall be deemed by the appeals officer to bea denial of the request.
3. If a notice of appeal is not filed as required bythis section, the imposition of or refusal to impose the benefit penalty shallbe deemed a final order and is not subject to review by any court or agency.
4. A hearing held pursuant to this section must beconducted by the appeals officer as a hearing de novo. The appeals officershall render a written decision on the appeal. Except as otherwise provided inthis section, the provisions of NRS616C.345 to 616C.385, inclusive,apply to an appeal filed pursuant to this section.
5. A benefit penalty imposed pursuant to
6. Any party aggrieved by a decision issued pursuantto this section by an appeals officer may appeal the decision directly to thedistrict court.
(Added to NRS by 1993, 691; A 1995, 1639;
NRS
1. If a person wishes to contest a decision of theAdministrator to impose an administrative fine pursuant to this chapter or
2. A person who is aggrieved by a writtendetermination of the Administrator may appeal from the determination by filinga request for a hearing before an appeals officer. The request must be filedwithin 30 days after the date on which the notice of the Administratorsdetermination was mailed by the Administrator.
3. If a notice of appeal is not filed as required bythis section, the imposition of the administrative fine shall be deemed a finalorder and is not subject to review by any court or agency.
4. An administrative fine imposed pursuant to thischapter or chapter 616A,
(Added to NRS by
NRS
(Added to NRS by 1981, 1454; A 1987, 655; 1991, 2401;1995, 1640)(Substituted in revision for NRS 616.221)
PROHIBITED ACTS
NRS
1. If the Administrator finds that an employerwithin the provisions of NRS 616B.633has failed to provide and secure compensation as required by the terms of
(a) The premiums that would otherwise have been owed toa private carrier pursuant to the terms of chapters616A to 616D, inclusive, or
(b) Interest at a rate determined pursuant to
The moneycollected pursuant to this subsection must be paid into the UninsuredEmployers Claim Account.
2. The Administrator shall deliver a copy of hisdetermination to the employer. An employer who is aggrieved by thedetermination of the Administrator may appeal from the determination pursuantto subsection 2 of NRS 616D.220.
3. Any employer within the provisions of
(a) Except as otherwise provided in paragraph (b), ifit is a first offense, for a misdemeanor.
(b) If it is a first offense and, during the period theemployer was doing business in this State without providing, securing ormaintaining compensation, one of his employees suffers an injury arising out ofand in the course of his employment that results in substantial bodily harm tothe employee or the death of the employee, for a category C felony punishableby imprisonment in the state prison for a minimum term of not less than 1 yearand 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 committedwithin 7 years after the previous offense, for a category C felony punishableby imprisonment in the state prison for a minimum term of not less than 1 yearand 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 pursuantto paragraph (b) or (c) of subsection 3, the court shall order the employer to:
(a) Pay restitution to an insurer who has incurredcosts as a result of the violation in an amount equal to the costs that havebeen incurred minus any costs incurred that have otherwise been recovered; and
(b) Reimburse the uninsured employers claim accountfor all payments made from the account on the employers behalf, including anybenefits, administrative costs or attorneys fees paid from the account, thathave not otherwise been recovered pursuant to
5. Any criminal penalty imposed pursuant tosubsections 3 and 4 must be in addition to the amount charged pursuant tosubsection 1.
[32:168:1947; A 1949, 659; 1943 NCL 2680.32](NRS A1967, 636; 1981, 1498; 1991, 2426; 1993, 754; 1995, 1873; 1997, 568, 570, 1191,1442, 1457, 3222, 3224; 1999,228, 250,
NRS
1. Any person who:
(a) Is the legal or beneficial owner of 25 percent ormore of a business which terminates operations while owing a premium, interestor penalty to a private carrier and becomes, or induces or procures anotherperson to become, the legal or beneficial owner of 25 percent or more of a new businessengaging in similar operations; or
(b) Knowingly aids or abets another person in carryingout such conduct,
is liable ina civil action for the payment of any premium, interest and penalties owed tothe private carrier and the reasonable costs incurred by the private carrier toinvestigate and act upon such conduct.
2. The private carrier shall not knowingly insure anybusiness which engages in the conduct described in subsection 1 unless thepremium and any interest and penalties owed to the prior insurer have been paidto that insurer.
3. As used in this section, business includes, butis 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;
NRS
1. If the Administrator finds that any employer or anyemployee, officer or agent of any employer has knowingly:
(a) Made a false statement or has knowingly failed toreport a material fact concerning the amount of payroll upon which a premium isbased; or
(b) Misrepresented the classification or duties of anemployee,
he shallmake a determination thereon and charge the employers account an amount equalto the amount of the premium that would have been due had the properinformation been submitted. The Administrator shall deliver a copy of hisdetermination to the employer. The money collected pursuant to this subsectionmust be paid into the Uninsured Employers Claim Account.
2. An employer who is aggrieved by the determinationof the Administrator may appeal from the determination by filing a request fora hearing. The request must be filed within 30 days after the date on which acopy of the determination was delivered to the employer. The Administratorshall hold a hearing within 30 days after he receives the request. Thedetermination of the Administrator made pursuant to a hearing is a finaldecision for the purposes of judicial review. The amount of the determinationas finally decided by the Administrator becomes due within 30 days after thedetermination is served on the employer.
3. A person who knowingly:
(a) Makes a false statement or representation or whoknowingly fails to report a material fact concerning the amount of payroll uponwhich a premium is based; or
(b) Misrepresents the classification or duties of anemployee,
is guilty ofa gross misdemeanor. Any criminal penalty imposed must be in addition to theamount 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;
NRS
1. An employer who fails to pay an amount of moneycharged to him pursuant to the provisions of
(a) Any amount charged to the employer by theAdministrator pursuant to NRS 616D.200or 616D.220;
(b) Not more than $10,000 for each act of willfuldeception;
(c) An amount equal to three times the total amount ofthe reasonable expenses incurred by the State in enforcing this section; and
(d) Payment of interest on the amount charged at therate fixed pursuant to NRS 99.040 forthe period from the date upon which the amount charged was due to the date uponwhich the amount charged is paid.
2. A criminal action need not be brought against anemployer described in subsection 1 before civil liability attaches under thissection.
3. Any payment of money charged pursuant to theprovisions of NRS 616D.200 or
4. Any penalty collected pursuant to paragraph (b) or(c) of subsection 1 must be used to pay the salaries and other expenses of theFraud Control Unit for Industrial Insurance established pursuant to theprovisions of NRS 228.420. Any moneyremaining at the end of any fiscal year does not revert to the State GeneralFund.
(Added to NRS by 1995, 1871; A 1997, 1443;
NRS
1. Any employer who makes any charge against anyemployee or who deducts from the wages of any employee any sum of money to meetthe costs, in whole or in part, of the liability incurred by the employer byreason of his acceptance or rejection of chapters616A to 616D, inclusive, or
2. An employer who is required to provide compensationpursuant to the provisions of chapters 616Ato 616D, inclusive, or
3. Any employer violating any provision of thissection must be prosecuted by the Attorney General upon complaint of anyemployee who, as determined by the Attorney General, submits proper evidence ofa violation.
[38:168:1947; 1943 NCL 2680.38](NRS A 1967, 637;1987, 599; 1991, 2427; 1993, 756; 1995, 171;
NRS
1. A self-insured employer, a member of an associationof self-insured public or private employers or an employer insured by a privatecarrier who refuses to submit his books, records and payroll to theAdministrator or the private carrier for inspection as provided by
2. The person who makes such refusal is guilty of amisdemeanor.
[Part 80:168:1947; 1943 NCL 2680.80](NRS A 1981,1498; 1993, 1873; 1995, 2034;
NRS
1. If an employer refuses to produce any book, record,payroll report or other document in conjunction with an audit conducted by aprivate carrier or the Department of Taxation to verify the employers premium,the Administrator may issue a subpoena to require the production of thatdocument.
2. If an employer refuses to produce any document asrequired by the subpoena, the Administrator may report to the district court bypetition, setting forth that:
(a) Due notice has been given of the time and place ofthe production of the document;
(b) The employer has been subpoenaed by theAdministrator pursuant to this section; and
(c) The employer has failed or refused to produce thedocument required by the subpoena,
and askingfor an order of the court compelling the employer to produce the document.
3. Upon such petition, the court shall enter an orderdirecting the employer to appear before the court at a time and place to befixed by the court in its order, the time to be not more than 10 days after thedate of the order, and to show cause why he has not produced the document. Acertified copy of the order must be served upon the employer.
4. If it appears to the court that the subpoena wasregularly issued by the Administrator, the court shall enter an order that theemployer produce the required document at the time and place fixed in theorder. Failure to obey the order constitutes contempt of court.
(Added to NRS by 1991, 2390; A 1993, 1873; 1997,1444; 1999, 1800)
NRS
1. To post the notice required by
2. To maintain the notice or notices required by
[Part 36:168:1947; 1943 NCL 2680.36](NRS A 1991,2429; 1995, 2034)
NRS
[Part 83:168:1947; A 1949, 659; 1943 NCL 2680.83](NRS A 1981, 1499; 1993, 1876)(Substituted in revision for NRS616.670)
NRS
1. If the amount of the benefit or payment obtained orattempted to be obtained was less than $250, for a misdemeanor.
2. If the amount of the benefit or payment obtained orattempted to be obtained was $250 or more, for a category D felony as providedin NRS 193.130.
In additionto 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;
NRS
(Added to NRS by 1991, 2391; A 1993, 760; 1995, 1309;1999, 230)
NRS
1. An employer shall not knowingly offer employment orcontinue to employ a person who is receiving payments for a temporary totaldisability in violation of the provisions of chapters616A to 616D, inclusive, or
2. An employer who is convicted of violating theprovisions of subsection 1 is guilty of a gross misdemeanor.
(Added to NRS by 1995, 1872; A
NRS
1. An insurer, an employer, an organization formanaged care, a third-party administrator or the representative of any of thosepersons, the Nevada Attorney for Injured Workers or an attorney or othercompensated representative of an injured employee shall not initiate:
(a) Any oral communication relating to the medicaldisposition of the claim of an injured employee with the injured employeesexamining or treating physician or chiropractor unless the initiator of theoral communication:
(1) Maintains, in written form or in a form fromwhich a written record may be produced, a log that includes the date, time andsubject matter of the communication; and
(2) Makes the log available, upon request, toeach insurer, organization for managed care and third-party administratorinterested in the claim or the representative of each of those persons, theAdministrator and the injured employee, his representative and his employer; or
(b) Any written communication relating to the medicaldisposition of the claim with the injured employees examining or treatingphysician or chiropractor unless a copy of the communication is submitted tothe injured employee or his representative in a timely manner.
2. If the Administrator determines that a person hasviolated the provisions of this section, he shall:
(a) For an initial violation, issue a notice ofcorrection.
(b) For a second violation, impose an administrativefine of not more than $250.
(c) For a third or subsequent violation, impose anadministrative fine of not more than $1,000.
(Added to NRS by 1997, 1789)
FRAUDULENT PRACTICES
NRS
1. Charge means any communication, whether oral,written, electronic or magnetic, which is used to identify specific accidentbenefits as reimbursable pursuant to chapters616A to 616D, inclusive, or
2. Provider of health care means a person whoreceives or attempts to receive payment from:
(a) An insurer;
(b) A third-party administrator; or
(c) An organization for managed care which hascontracted with an insurer or third-party administrator,
for accidentbenefits provided or alleged to have been provided to an injured employeepursuant to the provisions of chapters 616Ato 616D, inclusive, or
3. Record means any medical, professional orbusiness 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
1. A person shall be deemed to know that a charge,statement or representation is false if he knows, or by virtue of his 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 tobe made a charge, statement or representation if he:
(a) Had the authority or responsibility to:
(1) Make the charge, statement orrepresentation;
(2) Supervise another person who made the charge,statement or representation; or
(3) Authorize the making of the charge,statement or representation,
whether byoperation of law, business or professional practice or office procedure; and
(b) Exercised that authority or responsibility orfailed to exercise that authority or responsibility and, as a direct orindirect result, the charge, statement or representation was made.
(Added to NRS by 1993, 681)(Substituted in revisionfor NRS 616.677)
NRS
1. A person shall not, by any act or omission:
(a) Make a charge or cause it to be made knowing thecharge to be false, in whole or in part;
(b) Make or cause to be made a statement orrepresentation for use in obtaining or seeking to obtain authorization toprovide specific accident benefits pursuant to chapters616A to 616D, inclusive, or
(c) Make or cause to be made a statement orrepresentation for use by another person to obtain accident benefits pursuantto chapters 616A to
2. A person who violates any of the provisions of thissection shall be punished:
(a) If the amount of the charge or the value of theaccident benefits obtained or sought to be obtained was $250 or more, for acategory 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 theaccident benefits obtained or sought to be obtained was less than $250, for amisdemeanor, and must be sentenced to restore any accident benefits soobtained, if it can be done, or tender payment for rent or labor.
(Added to NRS by 1993, 681; A 1995,1308)(Substituted in revision for NRS 616.678)
NRS
1. Each invoice for payment for accident benefitsprovided to an injured employee must:
(a) Contain a statement that all matters stated thereinare true and accurate; and
(b) Be signed by a natural person who is the providerof health care or is authorized to act for the provider of health care.
2. A person who, by any act or omission, signs orsubmits, or causes to be signed or submitted, the statement required bysubsection 1, knowing that the invoice contains information which is false, inwhole or in part, is guilty of a gross misdemeanor.
3. For the purposes of this section, a person whosigns on behalf of a provider of health care is presumed to have theauthorization of the provider of health care and to be acting at his direction.
4. As used in this section, to sign means to affix asignature directly or indirectly by means of handwriting, a typewriter, astamp, a computer impulse or other means.
(Added to NRS by 1993, 681)(Substituted in revisionfor NRS 616.679)
NRS
1. Except as otherwise provided in subsection2, a person shall not:
(a) While acting on behalf of a provider of healthcare, purchase or lease goods, services, materials or supplies for whichpayment may be made, in whole or in part, pursuant to
(b) Sell or lease to or for the use of a provider ofhealth care goods, services, materials or supplies for which payment may bemade, in whole or in part, pursuant to chapters616A to 616D, inclusive, or
(c) Refer a person to a provider of health care foraccident benefits for which payment may be made, in whole or in part, pursuantto chapters 616A to
2. Paragraphs (a) and (b) of subsection 1 do not applyif the additional value transferred is:
(a) A refund or discount made in the ordinary course ofbusiness;
(b) Reflected by the books and records of the persontransferring or receiving it; and
(c) Reflected in the charges submitted to the insurer.
3. A provider of health care shall not offer, transferor pay anything of value in connection with or in return for the referral tothe provider of a patient for whom payment of accident benefits may be made, inwhole or in part, pursuant to chapters 616Ato 616D, inclusive, or
4. A person shall not, while acting on behalf of aprovider of health care pursuant to chapters616A to 616D, inclusive, or
5. A person who violates any provision of thissection, if the value of the thing or any combination of things unlawfullysolicited, accepted, offered, transferred, paid, charged or received:
(a) Is less than $250, is guilty of a grossmisdemeanor.
(b) Is $250 or more, is guilty of a category D felonyand shall be punished as provided in NRS193.130.
(Added to NRS by 1993, 682; A 1995, 1308; 1997, 3223)
NRS
1. A person who, upon submitting a charge for or uponreceiving payment for accident benefits pursuant to
2. A person who fails to make such records availableto the Attorney General or the Administrator upon reasonable request is guiltyof a gross misdemeanor.
3. A person who intentionally destroys such recordswithin 5 years after the date payment was received is guilty of a category Dfelony and shall be punished as provided in NRS193.130.
(Added to NRS by 1993, 682; A 1995, 1309;
NRS
1. Any of the provisions of
2. Any of the provisions of
(Added to NRS by 1993, 684; A 1997, 3224)
NRS
1. No provider of health care who has been convictedof violating any provision of NRS 616D.370to 616D.410, inclusive, may, for 5years after the date of the first conviction or at any time after the date of asecond or subsequent conviction, receive or accept a payment for accidentbenefits provided or alleged to have been provided to an injured employeepursuant to the provisions of chapters 616Ato 616D, inclusive, or
2. A person who violates any provision of this sectionis guilty of a gross misdemeanor.
(Added to NRS by 1995, 1872)
NRS
1. A person who receives a payment or benefit to whichhe is not entitled by reason of a violation of any of the provisions of
(a) An amount equal to three times the amountunlawfully obtained;
(b) Not less than $5,000 for each act of deception;
(c) An amount equal to three times the total amount ofthe reasonable expenses incurred by the State in enforcing this section; and
(d) Payment of interest on the amount of the excesspayment at the rate fixed pursuant to NRS99.040 for the period from the date upon which payment was made to the dateupon which repayment is made.
2. A criminal action need not be brought against aperson who receives a payment or benefit to which he is not entitled by reasonof a violation of any of the provisions of NRS616D.300, 616D.370,
3. A person who unknowingly accepts a payment inexcess of the amount to which he is entitled is liable for the repayment of theexcess amount. It is a defense to any action brought pursuant to thissubsection that the person returned or attempted to return the amount which wasin excess of that to which he was entitled within a reasonable time afterreceiving it.
4. Any repayment of money collected pursuant toparagraph (a) or (d) of subsection 1 must be paid to the insurer who made thepayment to the person who violated the provisions of this section. Any paymentmade to an insurer may not exceed the amount paid by the insurer to thatperson.
5. Any penalty collected pursuant to paragraph (b) or(c) of subsection 1 must be used to pay the salaries and other expenses of theFraud Control Unit for Industrial Insurance established pursuant to
(Added to NRS by 1993, 683; A 1995, 1875;
NRS
1. An insurer may withhold any payment due a providerof health care pursuant to the provisions of chapters616A to 616D, inclusive, or
2. The insurer shall, within 5 days after withholdingsuch a payment, send notice of the withholding to the provider of health careby 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 insurersinvestigation;
(b) Indicate that the payment is being withheld pursuantto the provisions of this section;
(c) Indicate that the payment is being withheldtemporarily, as set forth in subsection 4, and describe the circumstances underwhich the withholding will be terminated;
(d) Specify the charge submitted by the provider ofhealth care for which the payment is being withheld; and
(e) Notify the provider of health care of his right toappeal the withholding.
3. A provider of health care may appeal the decisionof the insurer to withhold payment to an appeals officer pursuant to
4. Any payment withheld pursuant to the provisions ofthis section must be made to the provider of health care if:
(a) The insurer or the Attorney General determines thatthere is insufficient evidence to prove that the provider of health careknowingly made a false statement or representation or knowingly concealed amaterial fact to obtain the payment; or
(b) A final judgment or decree was rendered in favor ofthe provider of health care in a criminal proceeding arising out of the allegedmisconduct.
(Added to NRS by 1993, 683; A 1997, 1444)
REPORTING VIOLATIONS
NRS
1. An insurer, organization for managed care,health care provider, employer, third-party administrator or public officer whobelieves, or has reason to believe, that:
(a) A fraudulent claim for benefits under a policy ofinsurance has been made, or is about to be made;
(b) An employer within the provisions of
(1) Knowingly made a false statement orrepresentation concerning the amount of payroll upon which a premium is based;or
(2) Failed to provide and secure compensationunder the terms of chapters 616A to
(c) A provider of health care has submitted an invoicefor payment for accident benefits that contains information which the providerknows is false; or
(d) A person has committed any other fraudulentpractice under this chapter or chapter 616A,616B, 616Cor 617 of NRS,
shall reportthat belief to the Fraud Control Unit for Industrial Insurance establishedpursuant to NRS 228.420.
2. The Fraud Control Unit for Industrial Insuranceestablished pursuant to NRS 228.420 mayrequire a person who submits a report pursuant to subsection 1 to submit thatreport on a form prescribed by the Unit.
(Added to NRS by 1997, 3218; A
NRS
1. The Administrator, in accordance with theestablished procedures, reports to the Unit violations of the provisions of
2. For the purposes of
3. The Administrator and the Unit share otherinformation of which they are aware relating to violations of the provisions ofNRS 616D.200,
(Added to NRS by 1997, 3219)
PROSECUTION
NRS
1. The Attorney General may prosecute all criminalactions for the violation of any of the provisions of
2. Upon request, any person shall furnish to theAttorney General information which would assist in the prosecution of anyperson alleged to have violated any of the provisions of
(Added to NRS by 1993, 684; A 1995,1876)(Substituted in revision for NRS 616.710)
NRS
1. The books, records and payrolls of an employerpertinent to the investigation of a violation of any of the provisions of
2. If an employer refuses to produce any book, record,payroll report or other document in conjunction with an investigation conductedby the Fraud Control Unit for Industrial Insurance, the Attorney General mayissue a subpoena to require the production of that document.
3. If an employer refuses to produce any document asrequired by the subpoena, the Attorney General may report to the district courtby petition, setting forth that:
(a) Due notice has been given of the time and place ofthe production of the document;
(b) The employer has been subpoenaed by the AttorneyGeneral pursuant to this section; and
(c) The employer has failed or refused to produce thedocument required by the subpoena,
and askingfor an order of the court compelling the employer to produce the document.
4. Upon such petition, the court shall enter an orderdirecting the employer to appear before the court at a time and place to befixed by the court in its order, the time to be not more than 10 days after thedate of the order, and to show cause why he has not produced the document. Acertified copy of the order must be served upon the employer.
5. If it appears to the court that the subpoena wasregularly issued by the Attorney General, the court shall enter an order thatthe employer produce the required document at the time and place fixed in theorder. Failure to obey the order constitutes contempt of court.
(Added to NRS by 1993, 684; A 1995,1876)(Substituted in revision for NRS 616.720)
NRS
1. If a person is convicted of violating any of theprovisions of NRS 616D.200,
(a) Forfeits all rights to compensation under
(b) Is liable for:
(1) The reasonable costs incurred by an insurerand the office of the Attorney General to investigate and act upon theviolation;
(2) All costs incurred for the prosecution ofthe person by the court in which the conviction was obtained; and
(3) The payments or benefits fraudulentlyobtained under chapters 616A to
2. A judgment of conviction entered against the personmust contain a provision which requires the person convicted to pay the costsof investigation and prosecution and the payments or benefits specified insubsection 1.
3. Any money received by the Attorney General pursuantto subparagraph (1) of paragraph (b) of subsection 1 must be used to pay thesalaries and other expenses of the Fraud Control Unit for Industrial Insuranceestablished pursuant to NRS 228.420. Anymoney remaining at the end of any fiscal year does not revert to the StateGeneral Fund.
(Added to NRS by 1993, 685; A 1993, 2450; 1995,1877)(Substituted in revision for NRS 616.730)
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