Insurance fraud is any deliberate deception committed against or by an insurance company, insurance agent, or consumer for the purpose of unjustified financial gain. This occurs during the process of buying, using, selling, and underwriting insurance.
The Insurance Fraud Prevention Division is a certified law enforcement division whose duties and responsibilities are to conduct investigations independent of, or in conjunction with, law enforcement agencies when the Division has cause to believe that an act of insurance fraud has been or is currently being, committed.
Mandatory Reporting of Suspected Fraud (Insurance Companies and Producers) - Neb. Rev. Stat. § 44-393
Insurance Fraud Act
- 44-6601 - Act
- 44-6602 - Purpose
- 44-6603 - Terms, defined
- 44-6604 - Fraudulent Insurance Acts; enumerated
- 44-6605 - Immunity from Civil Liability
- 44-6606 - Insurance Fraud Prevention Division; Powers and Duties; Public Inspection; Limitations; Fee
- 44-6607 - Civil Penalty; Costs; Section, How Construed
- 44-6608 - Act, How Construed.
Crimes and Punishments, Article 6, Offenses Involving Fraud
- 28-631 - Fraudulent Insurance Act; Penalties
Mission
The mission of the Insurance Fraud Prevention Division is to confront the problem of insurance fraud in Nebraska by prevention, investigation, and prosecution of fraudulent insurance acts in an effort to reduce the amount of premium dollars used to pay fraudulent claims.
Division Creation
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.
While the Nebraska Department of Insurance does not require the filing of a fraud plan, it recognizes the importance of reducing operational risk through fraud awareness. As such, the Department would like to provide some guidance to carriers who wish to strengthen their fraud controls by creating and implementing an internal fraud policy.
During a market conduct and/or a financial examination, the Nebraska Department of Insurance may request a carrier to provide a summary of its anti-fraud activities and the corresponding results. Pursuant to Neb. Rev. Stat. § 44-5906 (8)(a), an anti-fraud summary provided to the Department in the course of an examination conducted under the Insurers Examination Act shall be given confidential treatment by the Department shall not be subject to subpoena, shall not be made public by any person except to the extent provided in Neb. Rev. Stat. § 44-5906(7), and shall not be public records subject to disclosure under public records request outlined in Neb. Rev. Stat. § 84-712 to 84-712.09.
Anti-fraud policies outline specific procedures appropriate to the lines of insurance the carrier writes in Nebraska, with the following suggestions, at a minimum:
- Preventing, detecting, and investigating all forms of insurance fraud covering insurance that the carrier is authorized to write in Nebraska, including, but not limited to:
- Fraud involving the carrier's employees or agents;
- Claims fraud; and
- Security of the carrier's data processing systems
- Fraud involving the carrier's employees or agents;
- Educating appropriate employees on fraud prevention and detection, the Nebraska Mandatory Fraud Reporting Statute, Neb. Rev. Stat. § 44-393, and the carrier's anti-fraud policy.
- Informing policyholders about insurance fraud and how to prevent it
- Encouraging the reporting of suspected incidents of insurance fraud to the Insurance Fraud Prevention Division of the Nebraska Department of Insurance.
- Encouraging legal pursuit of restitution for financial loss caused by insurance fraud where appropriate.
- Designating or identifying the person responsible for oversight and implementation of the carrier's anti-fraud policy.
Nebraska Department of Insurance
Insurance Fraud Prevention Division
1526 K Street, Suite 200
Lincoln, NE 68509-5087
Telephone: 402-471-2201
Facsimile: 402-742-8313
Email: DOI.FraudPrevention@Nebraska.gov
Kimberly P. Church, SCLA, CIFI, AHFI
Fraud Division Chief
Telephone: 402-471-4999 & 402-471-8334
Email: Kimberly.Church@Nebraska.gov
John McGahan
Fraud Investigator
Telephone: 402-471-1842
Email: John.McGahan@Nebraska.gov
Charles P. Starr, SCLA, CIFI, AHFI
Fraud Investigator
Telephone: 402-471-8334
Email: Charles.Starr@Nebraska.gov
Robert Branch Jr.
Fraud Investigator
Telephone: 402-471-8333
Email: Robert.Branch@Nebraska.gov
Connie C. Drake
Administrative Assistant
Telephone: 402-471-8336
Email: Connie.Drake@Nebraska.gov
Videos
Quarterly Court Actions Highlights
Sarpy County District Court, Case CR23-496
State v. Rebeca R. Antunez
Fraud Type: Auto Property - Past Posting
Rebeca Antunez was charged in Sarpy County with one felony count of insurance fraud.
Rebeca Antunez took out an auto policy providing comprehensive and collision coverage for her vehicle. Later that day she filed a collision claim stating she was just in an accident. Ms. Antunez provided the policy information to the other driver, who filed a liability claim for damage to her vehicle. Ms. Antunez provided a statement to the claims handler and affirmed her policy was incepted prior to the accident. However, the claimant's scene photos and the police report confirmed the accident occurred prior to the inception of her policy. As a result, Ms. Antunez's collision claim was denied, and the claimant suffered an out-of-pocket loss of $9,027.37.
Ms. Antunez pled guilty to an amended count fo fraudulent insurance act, a Class I misdemeanor. Ms. Antunez was sentenced to two years' probation, community service 20 hours, court costs and fees.
Sarpy County District Court, Case CR22-881
State v. Stephanie N. Lysholm
Fraud Type: Auto Property - Vehicle Theft
Stephanie Lysholm was charged in Sarpy County with one felony count of insurance fraud.
Stephanie Lysholm took out an auto policy providing comprehensive and collision coverage for her vehicle. Ms. Lysholm lowered her comprehensive deductible and added rental coverage. Approximately one-week later Ms. Lysholm reported her vehicle stolen. During the claim investigation it was discovered that Ms. Lysholm gave her vehicle to a known party to settle a debt. As a result of Ms. Lysholm's misrepresentation, the insurer suffered a potential loss of $5,056.04 based on the vehicle's valuation.
Ms. Lysholm pled no contest to an amended count of attempted fraudulent insurance act, Class I misdemeanor. Ms. Lysholm was sentenced to two years' probation, community service 20 hours, court costs and fees.
Douglas County District Court, Case CR23-3196
State v. Tenisha E. Roddy
Fraud Type: Medical/Health - Falsified/Forged Documents
Tenisha Roddy was charged with one felony count of insurance fraud.
Tenisha Roddy was employed as a claim handler with a national insurer. Ms. Roddy obtained three supplemental medical benefit policies through her employer. During the course of her employment, Ms. Roddy processed and received supplemental payments for six invalid claims pursuant to her policies. In addition, Ms. Roddy changed the direct deposit information on six unrelated policies to a bank account under her control. Ms. Roddy then processed and paid 57 invalid claims against those policies. As a result of Ms. Roddy's actions her employer suffered and actual loss of $3,085 and a potential loss of $450.
Ms. Roddy pled no contest to an amended count of attempted insurance fraud, a Class I misdemeanor. Ms. Roddy was sentenced to 18-months' probation, ordered to pay restitution to the insurer and the Insurance Fraud Prevention Division's investigative costs, court costs and fees.
