Purpose
The purpose of the Insurance Fraud Act is to confront the problem of insurance fraud in Nebraska by:
- Detecting insurance fraud
- Developing fraud prevention programs
- Investigating complaints of suspicious insurance activity
- Seeking prosecution of individuals committing insurance fraud
- Obtaining restitution of fraudulently obtained benefits
The ultimate goal is to reduce the amount of premium dollars used to pay fraudulent claims.
Immunity
The Insurance Fraud Act also provides immunity from civil liability to any person or entity that reports suspected insurance fraud, without malice, fraudulent intent, or bad faith. The Insurance Fraud Act also provides insurer to insurer immunity. Insurance companies are immune from civil liability when they communicate amongst themselves regarding suspicious claims and insurance activity. This benefits not only insurance companies, but law enforcement as well. Sharing of information avoids the duplication of efforts. §44-6605
Insurance Fraud Violations (Criminal Prosecution)
The Insurance Fraud Act sets forth 12 separate acts which constitute insurance fraud. These 12 violations are set forth in the insurance code Neb.Rev.Stat. §44-6604 and repeated in the criminal code, Neb.Rev.Stat. §28-631.
- Claims Fraud
- Aid and Abetting Claims Fraud
- False Statement to Insurer (death/disability)
- False Statement to Insurer (contract, agreement, or instrument)
- Conversion of Premiums
- Embezzlement from Insurer
- Issuing or Possessing Fake Policies, Certificates, Identification Cards, Binders
- Filing False Documents with the Nebraska Department of Insurance
- Removes, Alters, Diverts, or Destroys Records of an Insurer or Agent
- Worker's Compensation Premium Avoidance
- Discount Medical Plan Operation
- Discount Medical Plan Fee Collection Failure to Provide Benefits
The Insurance Fraud Act follows the same grading of offenses as theft. Any violation under $500 is a misdemeanor and any violation $500 or greater is a felony. §28-631(2)(a)
