Nebraska Department of Insurance
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NEBRASKA DEPARTMENT OF INSURANCEINSURANCE FRAUD PREVENTION DIVISION 941 O Street, Suite 400 Lincoln, NE 68508-3639 |
Changes Effective July 20, 2002
§28-631
CRIMES AND PUNISHMENTS
ARTICLE 6
OFFENSES INVOLVING FRAUD
28-631.
Fraudulent insurance act; penalties. (1) A person or entity commits
a fraudulent insurance act if he or she:
(a) Knowingly
and with intent to defraud or deceive presents, causes to be presented,
or prepares with knowledge or belief that it will be presented to or by
an insurer, or any agent of an insurer, any statement as part of, in support
of, or in denial of a claim for payment or other benefit from an insurer
or pursuant to an insurance policy knowing that the statement contains
any false, incomplete, or misleading information concerning any fact or
thing material to a claim;
(b) Assists,
abets, solicits, or conspires with another to prepare or make any statement
that is intended to be presented to or by an insurer or person in connection
with or in support of any claim for payment or other benefit from an insurer
or pursuant to an insurance policy knowing that the statement contains
any false, incomplete, or misleading information concerning any fact or
thing material to the claim;
(c) Makes
any false or fraudulent representations as to the death or disability of
a policy or certificate holder or a covered person in any statement or
certificate for the purpose of fraudulently obtaining money or benefit
from an insurer;
(d) Knowingly
and willfully transacts any contract, agreement, or instrument which violates
this section;
(e) Receives
money for the purpose of purchasing insurance and converts the money to
the person's own benefit;
(f) Willfully
embezzles, abstracts, purloins, misappropriates, or converts money, funds,
premiums, credits, or other property of an insurer or person engaged in
the business of insurance;
(g) Knowingly
and with intent to defraud or deceive issues fake or counterfeit insurance
policies, certificates of insurance, insurance identification cards, or
insurance binders;
(h) Knowingly
and with intent to defraud or deceive possesses fake or counterfeit insurance
policies, certificates of insurance, insurance identification cards, or
insurance binders;
(i) Knowingly
and with intent to defraud or deceive makes any false entry of a material
fact in or pertaining to any document or statement filed with or required
by the Department of Insurance; or
(j) Knowingly
and with intent to defraud or deceive removes, conceals, alters, diverts,
or destroys assets or records of an insurer or person engaged in the business
of insurance or attempts to remove, conceal, alter, divert, or destroy
assets or records of an insurer or person engaged in the business of insurance.
(2)(a) A violation of subdivisions (1)(a) through (f) of this section is a Class III felony when the amount involved is one thousand five hundred dollars or more.
(b) A violation of subdivision (1)(a) through (f) of this section is a Class IV felony when the amount involved is five hundred dollars or more but less than one thousand five hundred dollars.
(c) A violation of subdivisions (1)(a) through (f) of this section is a Class I misdemeanor when the amount involved is two hundred dollars or more but less than five hundred dollars.
(d) A violation of subdivisions (1)(a) through (f) of this section is a Class II misdemeanor when the amount involved is less than two hundred dollars.
(e) For any second or subsequent conviction under subdivision (2)(c) of this section, the violation is a Class IV felony.
(f) A violation of subdivision (1)(g), (i), and (j) of this section is a Class IV felony.
(g) A violation of subdivision (1)(h) of this section is a Class I misdemeanor.
(3) Amounts taken pursuant to one scheme or course of conduct from one
person, entity, or insurer may be aggregated in the indictment or information
in determining the classification of the offense, except that amounts may
not be aggregated into more than one offense.
(4) In
any prosecution under this section, if the amounts are aggregated pursuant
to subsection (3) of this section, the amount involved in the offense shall
be an essential element of the offense that must be proved beyond a reasonable
doubt.
(5) A
prosecution under this section shall be in lieu of an action under section
44-6607.
(6) For
the purpose of this section:
(a) Insurer
means any person or entity transacting insurance as defined in section
44-102 with or without a certificate of authority issued by the director
of Insurance. Insurer also means health maintenance organizations,
legal service insurance corporations, prepaid limited health service organizations,
dental and other similar health service plans, and entities licensed pursuant
to the Intergovernmental Risk Management Act and the Comprehensive Health
Insurance Pool Act. Insurer also means an employer who is approved
by the Nebraska Workers' Compensation Court as a self-insurer; and
(b) Statement
includes, but is not limited to, any notice, statement, proof of loss,
bill of lading, receipt for payment, invoice, account, estimate of property
damages, bill for services, diagnosis, prescription, hospital or medical
records, X-rays, test result, or other evidence of loss, injury, or expense,
whether oral, written, or computer-generated.
Source: Laws 1995, LB 385, § 10; Laws 1997, LB 272, § 1; Laws 2000, LB 930, § 1; Laws 2002, LB 547, § 1. Effective date July 20, 2002.
Comprehensive Health Insurance
Pool Act, see section 44-4201.
Intergovernmental Risk
Management Act, see section 44-4301.