State Codes and Statutes

Statutes > Nebraska > Chapter28 > 28-631

28-631. Fraudulent insuranceact; penalties.(1) A person or entity commits a fraudulentinsurance act if he or she:(a) Knowingly and with intent to defraud or deceive presents, causesto be presented, or prepares with knowledge or belief that it will be presentedto 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 aninsurer or pursuant to an insurance policy knowing that the statement containsany false, incomplete, or misleading information concerning any fact or thingmaterial to a claim;(b) Assists, abets, solicits, or conspires with another to prepare ormake any statement that is intended to be presented to or by an insurer orperson in connection with or in support of any claim for payment or otherbenefit from an insurer or pursuant to an insurance policy knowing that thestatement contains any false, incomplete, or misleading information concerningany fact or thing material to the claim;(c) Makes any false or fraudulent representations as to the death ordisability of a policy or certificate holder or a covered person in any statementor certificate for the purpose of fraudulently obtaining money or benefitfrom an insurer;(d) Knowingly and willfully transacts any contract, agreement, or instrumentwhich violates this section;(e) Receives money for the purpose of purchasing insurance and convertsthe money to the person's own benefit;(f) Willfully embezzles, abstracts, purloins, misappropriates, or convertsmoney, funds, premiums, credits, or other property of an insurer or personengaged in the business of insurance;(g) Knowingly and with intent to defraud or deceive issues fake or counterfeitinsurance policies, certificates of insurance, insurance identification cards,or insurance binders;(h) Knowingly and with intent to defraud or deceive possesses fake orcounterfeit insurance policies, certificates of insurance, insurance identificationcards, or insurance binders;(i) Knowingly and with intent to defraud or deceive makes any falseentry of a material fact in or pertaining to any document or statement filedwith or required by the Department of Insurance;(j) Knowingly and withthe intent to defraud or deceive provides false, incomplete, or misleadinginformation to an insurer concerning the number, location, or classificationof employees for the purpose of lessening or reducing the premium otherwisechargeable for workers' compensation insurance coverage;(k) Knowingly and with intentto defraud or deceive removes, conceals, alters, diverts, or destroys assetsor records of an insurer or person engaged in the business of insurance orattempts to remove, conceal, alter, divert, or destroy assets or records ofan insurer or person engaged in the business of insurance;(l) Willfully operates asor aids and abets another operating as a discount medical plan organizationin violation of subsection (1) of section 44-8306; or(m) Willfully collects feesfor purported membership in a discount medical plan organization but purposefullyfails to provide the promised benefits.(2)(a) A violation of subdivisions (1)(a) through (f) of this sectionis a Class III felony when the amount involved is one thousand five hundreddollars or more.(b) A violation of subdivisions (1)(a) through (f) of this section isa Class IV felony when the amount involved is five hundred dollars or morebut less than one thousand five hundred dollars.(c) A violation of subdivisions (1)(a) through (f) of this section isa Class I misdemeanor when the amount involved is two hundred dollars or morebut less than five hundred dollars.(d) A violation of subdivisions (1)(a) through (f) of this section isa 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 subdivisions (1)(g), (i), (j), (k), (l), and (m) of this section is a ClassIV 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 oneperson, entity, or insurer may be aggregated in the indictment or informationin determining the classification of the offense, except that amounts maynot be aggregated into more than one offense.(4) In any prosecution under this section, if the amounts are aggregatedpursuant to subsection (3) of this section, the amount involved in the offenseshall be an essential element of the offense that must be proved beyond areasonable doubt.(5) A prosecution under this section shall be in lieu of an action undersection 44-6607.(6) For purposes of this section:(a) Insurer means any person or entity transacting insurance as definedin section 44-102 with or without a certificate of authority issued by theDirector of Insurance. Insurer also means health maintenance organizations,legal service insurance corporations, prepaid limited health service organizations,dental and other similar health service plans, discount medical plan organizations,and entities licensed pursuant to the Intergovernmental Risk Management Actand the Comprehensive Health Insurance Pool Act. Insurer also means an employerwho 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, estimateof property damages, bill for services, diagnosis, prescription, hospitalor medical records, X-rays, test result, or other evidence of loss, injury,or expense, whether oral, written, or computer-generated. SourceLaws 1995, LB 385, § 10; Laws 1997, LB 272, § 1; Laws 2000, LB 930, § 1; Laws 2002, LB 547, § 1; Laws 2008, LB855, § 2; Laws 2009, LB208, § 1. Cross ReferencesComprehensive Health Insurance Pool Act, see section 44-4201.Intergovernmental Risk Management Act, see section 44-4301.