Nebraska Fraud Reporting

Definition of “Fraudulent Insurance Act”

Neb. Rev. Stat. 44-6604 defines “fraudulent insurance acts”:

For purposes of the Insurance Fraud Act, a person or entity commits a fraudulent insurance act if he or she:

(1) Knowingly and with intent to defraud or deceive presents, causes to be presented, or prepares with knowledge or belief that it will be presented to 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 an insurer or pursuant to an insurance policy knowing that the statement contains any false, incomplete, or misleading information concerning any fact or thing material to a claim;

(2) Assists, abets, solicits, or conspires with another to prepare or make any statement that is intended to be presented to or by an insurer or person in connection with or in support of any claim for payment or other benefit from an insurer or pursuant to an insurance policy knowing that the statement contains any false, incomplete, or misleading information concerning any fact or thing material to the claim;

(3) Makes any false or fraudulent representations as to the death or disability of a policy or certificate holder or a covered person in any statement or certificate for the purpose of fraudulently obtaining money or benefit from an insurer;

(4) Knowingly and willfully transacts any contract, agreement, or instrument which violates this section;

(5) Receives money for the purpose of purchasing insurance and converts the money to the person's own benefit;

(6) Willfully embezzles, abstracts, purloins, misappropriates, or converts money, funds, premiums, credits, or other property of an insurer or person engaged in the business of insurance;

(7) Knowingly and with intent to defraud or deceive issues or possesses fake or counterfeit insurance policies, certificates of insurance, insurance identification cards, or insurance binders;

(8) Knowingly and with intent to defraud or deceive makes any false entry of a material fact in or pertaining to any document or statement filed with or required by the department;

(9) Knowingly and with intent to defraud or deceive removes, conceals, alters, diverts, or destroys assets or records of an insurer or person engaged in the business of insurance or attempts to remove, conceal, alter, divert, or destroy assets or records of an insurer or person engaged in the business of insurance;

(10) Knowingly and with the intent to defraud or deceive provides false, incomplete, or misleading information to an insurer concerning the number, location, or classification of employees for the purpose of lessening or reducing the premium otherwise chargeable for workers' compensation insurance coverage;

(11) Willfully operates as or aids and abets another operating as a discount medical plan organization in violation of subsection (1) of section 44-8306; or

(12) Willfully collects fees for purported membership in a discount medical plan but purposefully fails to provide the promised benefits.

Mandatory Fraud Reporting Statute(s)

Neb. Rev. Stat. 44-393 establishes the mandatory reporting requirement: Every insurance company, agent, solicitor, or broker, and every person or party having knowledge of violation of any of the provisions of this chapter, is required to promptly report the facts and circumstances pertaining thereto to the Department of Insurance, which report and the name of the informant may be held confidential by the department, its officers, assistants and employees, and not be made public.

How to Report Fraud

On-line Referral: The Company may submit an online referral through NAIC or through National Insurance Crime Bureau (NICB); the Company is responsible to make sure that the referral is received by the Nebraska Fraud Prevention Division. A letter confirming receipt of the referral will be sent to the Company.

Paper Referral: (1) Request a “suspected fraudulent claim report” by contacting the Fraud Prevention Division via telephone, letter, facsimile, email or visit the website: www.ReportInsuranceFraud.ne.gov; (2) Provide copies of documents that establish the claimant was insured (i.e. policy declarations); (3) Submit copies of documents showing the claim was submitted and, if applicable, (4) Supply copies of documents that support the belief the claim may be fraudulent; (5) Highlight any specific details that should be brought to the Division’s attention (i.e., false statements, altered figures, inconsistencies, etc.).

All original documents, along with the postmarked envelopes in which they were received, should be retained in the company’s file. In some cases, it may be necessary for an insurance fraud investigator to have access to the entire claim file. In these instances, the Division will make an official request in writing or by telephone to the insurance company representative for the entire file.