Is insurance fraud really a serious problem?
Insurance fraud is one of the costliest white-collar crimes in the United States, ranking second only to tax evasion. A recent study by Conning & Co. estimated that fraud cost the private insurance industry $96 billion dollars annually. Fraud and abuse in Medicare and Medicaid alone have been estimated to be over $100 billion dollars.
Who pays for insurance fraud?
You do. Contrary to popular opinion, insurance fraud is not a victimless crime. The cost of this crime is passed onto law-abiding citizens in the form of the increased cost to purchase and maintain insurance coverage. The Conning & Co. study estimated this crime costs families $5,000 each year. This amount includes not only higher premiums, but also the resulting higher prices for consumer goods and services.
Who do I contact if I am having difficulty with an insurance company and/or want general information about insurance within the State of Nevada?
The Insurance Commissioner's office is the entity with jurisdiction over insurance companies in the State of Nevada. They handle disputes between policyholders and their insurance company, and the Office of the Attorney General has jurisdiction over insurance fraud crimes.
Who commits insurance fraud?
Career criminals and organized crime groups, medical, legal, and business professionals, ordinary citizens, your next-door neighbor. The United States General Accounting Office has issued a report noting career criminals and organized criminal groups are committing health care fraud. Our office has information that this is true in other lines of insurance as well.
What is the penalty for someone convicted of insurance fraud?
Insurance fraud in this state is a felony. A person convicted of insurance fraud faces up to 4 years in prison, must pay restitution to the insurance company defrauded, may be ordered to pay our office's cost of investigation and prosecution, and may be order to pay up to $5,000.00 in fines.
How do you generally begin an insurance fraud investigation? How can someone report insurance fraud?
- Insurance companies are required by law to report suspicious insurance claims to us. Many companies have Special Investigative Units.
- The National Insurance Crime Bureau investigates and refers matters to us.
- Private citizens may report suspicious claims to any one of our main offices and may submit their suspicions to us on a form available online.
- Insurance fraud may also be reported to the National Insurance Crime Bureau NICB at 1 (800) T-E-L-N-I-C-B (835-6422).
How is the Insurance Fraud Unit organized? How are you funded?
The IFU has two prosecutors and three investigators in our Las Vegas office, one prosecutor and two investigators in our Reno office, as well as other support staff.
Our office criminally prosecutes statewide those who make or assist someone else in making material misrepresentations on applications for insurance and/or those who make false claims for benefits with insurance companies, i.e., lying to one's insurance company. While the Insurance Commissioner has jurisdiction over disputes between policyholders and their insurance companies, the IFU handles criminal (fraud) complaints. This applies to all types of insurance: homeowners, renters, life, automobile, property and casualty, health, etc.
The IFU is funded by a pro-rata sliding scale assessment against each insurance company operating in the State of Nevada. The assessment amount is based upon the total amount of premiums written by the company. The low end of the assessment is $500, with the maximum amount being $2,000. Eighty-five percent of this money is distributed to our office;15% goes to the insurance commissioner. We receive no general fund money to operate, i.e., tax dollars.