NRS: CHAPTER 616D - INDUSTRIAL INSURANCE: PROHIBITED ACTS; PENALTIES; PROSECUTION

[Rev. 6/29/2024 4:41:34 PM--2023]

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; agreement in settlement of penalty; disciplinary action for failure to make timely payment of 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.

NRS 616D.160 Administrator to post information concerning benefit penalties on Internet website of Division; database.

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 chiropractic physician 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.

(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.

(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)

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)

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 professional employer organization 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 professional employer organization 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.

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 professional employer organization to pay to the claimant a benefit penalty:

(a) Except as otherwise provided in paragraph (b), in an amount that is not less than $17,000 and not greater than $120,000; 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 professional employer organization 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 15 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 15 days after the date of the Administrator’s determination unless an appeal is filed pursuant to NRS 616D.140 and a stay has been granted. 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 professional employer organization 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.

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; 2021, 1929; 2023, 3635)

NRS 616D.130 Investigation of alleged violation; determination of Administrator.

1. Upon receipt of a complaint for a violation of subsection 1, 2 or 3 of NRS 616D.120, or if the Administrator has reason to believe that such a violation has occurred, the Administrator shall:

(a) Promptly provide a copy of the complaint, or an explanation of the reason the Administrator believes that a violation has occurred to:

(1) The Commissioner; and

(2) The insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization that allegedly committed the violation; and

(b) Cause to be conducted an investigation of the alleged violation.

2. The Administrator shall:

(a) Within 30 days after receipt of a complaint pursuant to subsection 1, initiate an investigation;

(b) Within 60 days after the date on which the investigation is initiated, complete the investigation; and

(c) Within 30 days after the investigation is completed, render a determination and deliver a copy of the determination to:

(1) The Commissioner; and

(2) The insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization that was the subject of the investigation.

3. The determination rendered pursuant to subsection 2 must include the Administrator’s findings of fact, any settlement agreement on the matter and, if the Administrator determines that a violation has occurred, one or more of the following:

(a) The amount of any fine required to be paid pursuant to NRS 616D.120.

(b) The amount of any benefit penalty required to be paid to a claimant pursuant to NRS 616D.120.

(c) 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.

(d) A requirement that notice of the violation be given to the appropriate agency that regulates the activities of the violator.

4. 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; 2023, 3638)

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 120 days to a complaint filed pursuant to NRS 616D.130 and received by the Administrator from 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 150 days after the date on which the unanswered complaint was received by the Administrator, as applicable. The failure of the Administrator to respond within 120 days after receipt of the complaint shall be deemed by the appeals officer to be a denial of any allegation of a violation of subsection 1, 2 or 3 of NRS 616D.120 set forth in the complaint. After the expiration of the 120-day period after receipt of the complaint, the Administrator shall have no further jurisdiction to issue a determination concerning the complaint, and only the appeals officer shall have jurisdiction over the decision to impose or refuse to impose the benefit penalty.

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.

7. If an appeals officer or district court renders a decision upholding the imposition of a benefit penalty, the insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization upon which the benefit penalty is imposed shall, not later than 30 days after the date on which the decision is rendered, unless an appeal is filed and a stay has been granted, pay to the claimant the benefit penalty in an amount equal to twice the amount of the benefit penalty initially imposed.

8. If a claimant enters into a settlement agreement with an insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization concerning the amount of a benefit penalty owed to the claimant, the insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization shall pay directly to the claimant the amount agreed upon in the settlement agreement not later than 15 days after the date on which the settlement agreement is made.

9. If an insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization fails to pay a benefit penalty to a claimant within the time limits imposed by this section or subsection 4 of NRS 616D.120, the Commissioner may suspend, pending an investigation or any other disciplinary action, any certificate issued by the Commissioner to the insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization, as applicable.

(Added to NRS by 1993, 691; A 1995, 1639; 2003, 1681; 2023, 3639)

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)

NRS 616D.160 Administrator to post information concerning benefit penalties on Internet website of Division; database.

1. If the Administrator orders an insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization to pay a benefit penalty pursuant to NRS 616D.120, the Administrator shall post on the Internet website of the Division:

(a) The full legal name of the insurer, organization for managed care, health care provider, third-party administrator, employer or professional employer organization;

(b) The amount of the benefit penalty imposed; and

2. The information required by subsection 1 must:

(a) Be published not more than 30 days after the date on which the time for taking an appeal on the order to impose the benefit penalty has elapsed or the date on which all appeals regarding the order have been exhausted and the order to impose the benefit penalty has been upheld, whichever is later.

(b) Remain posted on the Internet website of the Division for not less than 5 years after the date on which it is initially posted.

3. The Administrator shall establish and maintain on the Internet website of the Division a database which:

(a) Contains the information required by subsection 1;

(b) Is publicly accessible;

(d) Is updated regularly.

(Added to NRS by 2023, 3634)

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)

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

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 chiropractic physician 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 chiropractic physician 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 chiropractic physician 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.

(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

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

(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

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

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)

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)