Nevada “Insurance Fraud” Laws – NRS § 686A.2815

NRS § 686A.2815 defines the Nevada crime of insurance fraud, which is knowingly and willfully submitting false or misleading information, or hiding important facts, in an insurance application or claim. The information must be material, meaning it matters to the application or claim.

Examples

• False applications: Giving an insurer, reinsurer, insurance producer, broker, or their agent application information you know is materially false, misleading, or incomplete.
• Fraudulent claims: Submitting, or causing someone else to submit, statements supporting a claim that you know contain material falsehoods or omissions.
• Helping with fraud: Knowingly aiding, encouraging, soliciting, or conspiring with someone else to carry out an insurance fraud scheme.
• Intentional deception: Acting, or deliberately failing to act, with the intent to deceive an insurer or other covered insurance professional to obtain a policy, proceeds, or benefits.
• Recruiting clients or patients for fraud: Hiring people to bring in clients or patients for a fraudulent insurance scheme.
• Accepting fraudulent proceeds: Taking insurance money or benefits you know came from insurance fraud.¹

Under NRS 686A.291, insurance fraud is a category D felony carrying:

• 1 to 4 years in Nevada State Prison;
• A possible fine of up to $5,000;
• Restitution for losses the court determines must be repaid; and
• Possible court costs and investigation and prosecution costs.²

The Nevada Attorney General’s Insurance Fraud Unit investigates and prosecutes these cases, with referrals and assistance from the Nevada Division of Insurance. A county district attorney may also prosecute with the Attorney General‘s permission or at its request.³

When defending these cases, we look beyond the insurer’s accusation. We examine who supplied the information, what you actually knew, and whether an apparent inconsistency has an innocent explanation. A confusing form, a billing mistake, or a disagreement over coverage does not by itself prove criminal fraud.

In this article, our Las Vegas criminal defense attorneys will address the following key issues regarding Nevada insurance fraud laws:

• 1. Elements
• 2. Investigations and Prosecution
• 3. Penalties
• 4. Defenses
• 5. Common Examples and Related Offenses
• 6. Reporting Insurance Fraud
• Frequently Asked Questions
• Additional Resources

1. Elements

In Nevada, prosecutors must prove every element of an insurance fraud offense beyond a reasonable doubt to get a conviction. For a false statement claim under NRS 686A.2815(1)(b), they must establish that:

1. You knowingly and willfully presented a statement, or caused it to be presented, as part of or in support of an insurance claim;
2. The statement concealed or omitted facts, or contained false or misleading information, about a material fact; and
3. You knew the statement had that defect.

The insurer does not have to pay the claim for you to be convicted of knowingly submitting a materially false claim statement.

The exact elements prosecutors have to prove depend on which part of the statute they charge. For example, knowingly accepting fraudulent proceeds is different from submitting a false application. A false application may also be charged under NRS 686A.290, which separately prohibits knowingly or willfully making false or fraudulent statements in or concerning an insurance application.⁴

The alleged falsehood can appear in more than the initial form. For example, knowingly submitting an altered repair invoice, a fabricated receipt, or a materially false recorded statement to support a claim can be evidence of insurance fraud.

Our defense review starts with the exact statement the prosecutor says was false. We compare it with the question asked, the surrounding communications, and the records available to you at the time. That can help show that you answered honestly, misunderstood the question, or did not know someone else had entered incorrect information.

2. Investigations and Prosecution

The Nevada Attorney General’s Insurance Fraud Unit handles criminal insurance fraud investigations and prosecutions. Insurers and the Division of Insurance refer suspected fraud to the unit.⁵

An investigation can begin before an arrest or formal charge. An insurance company may investigate a suspicious claim and refer its findings to law enforcement. A request for an interview may therefore come after investigators have already gathered records.

Investigators may review applications, claim forms, recorded calls, medical records, photographs, repair estimates, payment records, and communications between the people involved. An insurer’s decision to deny a claim does not establish guilt in a criminal case.

You may hear the terms hard fraud and soft fraud. Hard fraud generally describes an invented or staged loss. Soft fraud generally describes exaggerating an otherwise real claim. These are descriptive labels, not separate felony categories under NRS 686A.291.

We seek the complete claim file rather than relying on an investigator’s summary. Earlier statements, omitted attachments, and internal claim notes may undermine an accusation that looks convincing when only selected records are shown.

3. Penalties

Insurance fraud under NRS 686A.291 is a category D felony regardless of whether the claim is small or large. The Nevada State Prison range is one to four years, and the judge may impose a fine of up to $5,000. The judge may also order payment of court costs and the costs of investigating and prosecuting the fraud.⁶

Depending on the case, the judge may order restitution, which means repaying losses caused by the offense. It is separate from a fine. The amount must be supported by the case; it is not automatically the amount the insurer demands. NRS 686A.290 expressly requires restitution for insurance application fraud.⁷

Prison is not automatic in every case. An eligible defendant may receive probation and a suspended prison sentence. Eligibility and the judge’s decision depend on the conviction, criminal history, and applicable restrictions.⁸

We challenge unsupported loss calculations and costs as well as the charge itself. When negotiating a resolution, we present weaknesses in the evidence and facts supporting a reduced charge or probation. We do not assume that an insurer’s claimed loss is accurate simply because it appears in a spreadsheet.

Professional Licenses, Employment, and Civil Rights

An insurance fraud case can affect more than your sentence. Under NRS 686A.295, the Commissioner and Attorney General must notify the relevant Nevada licensing or registration agencies when a licensed professional is convicted of, or enters a specified guilty plea to, insurance fraud. Whether that leads to discipline, suspension, or loss of a license depends on the profession’s rules and the agency’s decision.⁹

A felony conviction can also create employment difficulties, especially for work involving money or sensitive records. Nevada generally prohibits a person convicted of a felony from owning or possessing firearms, unless the state grants a pardon.

Voting rights follow different rules: Eligible Nevada residents have their voting rights restored upon release from prison and may vote while on probation or parole.¹⁰

Before recommending a plea, we consider the particular conviction and admissions the agreement would require. We look for ways to challenge or narrow the allegations while also addressing the effect on your license, work, and rights.

4. Defenses

Here at Las Vegas Defense Group, we have represented countless people charged with fraud, including insurance fraud. In our experience, the following six defenses have proven very effective with prosecutors, judges, and juries in getting these cases reduced or dismissed.

1. An honest mistake: A typo, misunderstanding, or mistaken memory may explain the disputed information.
2. No material falsehood: For a material misstatement charge, perhaps the disputed fact does not matter to the application or claim.
3. Someone else’s actions: An agent, employee, medical biller, or another person may have entered information without your knowledge or approval.
4. An accurate claim: Photos, receipts, medical records, or witnesses may support what you reported in good faith.
5. No knowing participation: Knowing someone involved in fraud does not, by itself, establish that you knowingly helped the scheme.
6. Unreliable or unlawfully obtained evidence: Depending on the circumstances, we may challenge the accuracy or admissibility of the prosecution’s evidence.¹¹

A motion to suppress asks the judge to exclude evidence obtained unlawfully. Under NRS 179.085, grounds can include an unlawful search without a warrant, a defective warrant, lack of probable cause, or an illegally executed warrant. We assess whether your rights were violated and whether an exception allows the evidence to be used.

If the judge excludes important evidence, the prosecution may have a weaker case or insufficient proof to proceed. That can support a request for dismissal or a better negotiated outcome.¹²

We build the defense around documents and a timeline. For example, records showing when you learned a fact can undercut the claim that you deliberately hid it earlier. Original recordings may also show that an investigator’s account leaves out an important qualification or explanation.

5. Common Examples and Related Offenses

Insurance fraud and public-benefit fraud do not all carry the same penalties in Nevada. Auto and private health insurance schemes may fall under NRS 686A.2815 and 686A.291. Unemployment, welfare, and workers’ compensation fraud have separate statutes that must be checked against the conduct charged.

Car Insurance Fraud

Car insurance fraud in Nevada can involve a fabricated theft, staged accident, or knowingly false information about damage. A conviction under NRS 686A.291 carries the category D penalties discussed above.

A genuine accident does not make every part of a claim legitimate. For example, suppose your car suffers real collision damage, but you knowingly submit an altered repair estimate adding unrelated damage to increase the payout. The added material falsehood can support an insurance fraud charge even though the crash itself happened.¹³

When defending an auto claim, we compare repair records, original photos, accident reports, and the policy’s effective dates. These records may expose gaps in the insurer’s theory about when damage occurred or what you knew when you filed the claim.

Health Insurance Fraud

Health insurance fraud in Nevada may involve billing for services never provided, knowingly inflating charges, or falsifying records to obtain payment. A private insurance case prosecuted under NRS 686A.291 is a category D felony. Medicare and Medicaid cases may involve different state or federal statutes.

Under 18 U.S.C. § 1347, federal health care fraud generally carries up to 10 years in prison, plus a possible fine. The maximum increases to 20 years if serious bodily injury results and potentially life if death results. The separate false statements offense under 18 U.S.C. § 1035 generally carries up to five years, plus a possible fine.¹⁴

We examine who selected billing codes, submitted claims, and changed patient records. A disputed code or rejected bill does not, by itself, establish that a particular defendant knowingly participated in fraud.

Unemployment Insurance Fraud

Unemployment insurance fraud in Nevada includes knowingly making false statements or hiding material facts to obtain or increase benefits. One example is deliberately failing to report earnings.

• NRS 612.715: A qualifying false statement or omission is generally a misdemeanor, subject to the felony rule below.
• NRS 612.720: Specified conspiracies or a series of false statements over more than one week can be a gross misdemeanor, subject to the felony rule below.
• NRS 612.445(5): Fraudulently obtaining $1,200 or more is punished under Nevada’s theft sentencing provisions, with the penalty depending on the amount.

Repayment, administrative penalties, and disqualification from benefits may also apply.¹⁵

We compare weekly certifications with payroll records and the instructions you received. Confusion about which week to report earnings is different from deliberately hiding a job.

Welfare Fraud

Under NRS 422A.700, fraudulently obtaining or attempting to obtain $100 or more in public assistance (welfare fraud) is generally a category E felony, unless a different listed statute supplies the penalty.

The court must order restitution. Category E felonies generally carry probation and a suspended sentence, subject to statutory exceptions; the underlying prison range is 1 to 4 years.¹⁶

We review eligibility notices, household information, and records of reported changes. An overpayment alone does not establish intentional fraud. Proof that you disclosed a change or relied on agency instructions may undermine the prosecution’s case.

Workers’ Compensation Fraud

Under NRS 616D.300, knowingly making a false statement or concealing a material fact to obtain or attempt to obtain workers’ compensation benefits is generally:

• A misdemeanor if the benefit or payment obtained or sought was less than $250; or
• A category D felony if it was $250 or more.

Restitution is required. Other Nevada workers’ compensation fraud provisions cover different conduct and may carry different consequences.¹⁷

We compare medical restrictions, work records, and surveillance with the actual statements in the claim. A short video of physical activity does not necessarily prove that you could perform your job or that you knowingly misrepresented your condition.

6. Reporting Insurance Fraud

Suspected criminal insurance fraud can be reported to the Nevada Attorney General’s Insurance Fraud Unit. Use the reporting instructions on its official website. For help with coverage, claims handling, or other consumer insurance complaints, contact the Nevada Division of Insurance.¹⁸

If you are the person under investigation, preserve the original records and consult defense counsel before giving a detailed interview or written explanation. Do not alter documents or ask anyone to change their account.

We review the allegation and supporting records first so that any response addresses the evidence accurately and does not turn a misunderstanding into an apparent admission.

Frequently Asked Questions

Can I be convicted if the insurance company never paid me?

Yes. Knowingly and willfully submitting a materially false statement in support of an insurance claim can violate NRS 686A.2815 even if the insurer denies the claim or discovers the problem before paying. An actual payout is not required for that form of the offense.

We focus on what you submitted, what you knew, and whether the disputed information was material. The lack of payment may affect the loss calculation, but it does not automatically defeat the charge.

Is an honest mistake on an insurance form a crime?

An honest mistake does not satisfy the knowledge requirement for a false statement charge under NRS 686A.2815. Prosecutors must prove that you knew the statement contained materially false or misleading information or concealed or omitted material facts.

We look for records supporting your explanation, including unclear questions, earlier disclosures, and information entered by an agent or another person. The goal is to show why an inaccurate answer does not establish knowing fraud.

Can I get probation for insurance fraud in Nevada?

Possibly. Insurance fraud under NRS 686A.291 is a category D felony, but an eligible defendant may receive probation and a suspended prison sentence. Probation is not guaranteed and depends on the applicable law and the judge’s decision.

We evaluate the evidence and your eligibility before discussing a plea. When appropriate, we present reasons for a reduced charge or probation and challenge unsupported claims about the amount of loss.

Can I be charged for helping someone else submit a false claim?

Yes. NRS 686A.2815 covers specified forms of knowingly assisting, encouraging, soliciting, or conspiring in insurance fraud. You do not have to be the policyholder or personally receive the insurance money.

We examine your actual role and knowledge. Routine paperwork, a referral, or a connection to someone accused of fraud does not by itself prove that you knowingly helped carry out a fraudulent scheme.

Does repaying the insurance company make the criminal case go away?

No. Repayment does not automatically erase a completed insurance fraud offense or require prosecutors to dismiss the case. It may address some or all of the victim’s loss and may be relevant to negotiations or sentencing.

We review the evidence and any proposed repayment agreement before advising you to act. That helps avoid admitting a disputed amount or assuming that a private agreement with the insurer also resolves the criminal case.

Additional Resources

For more information, refer to:

• Nevada Division of Insurance – Insurance regulation and consumer assistance.
• Nevada Attorney General’s Insurance Fraud Unit – Criminal insurance fraud investigations and reporting information.
• Insurance Fraud Unit FAQs – Information about the unit’s role.
• NRS Chapter 686A – Nevada’s insurance trade practices and fraud statutes.

Also see our article on credit card fraud (NRS 205.760).

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Legal References