Nevada workers compensation provider fraud occurs when one of the medical caregivers for the injured worker, such as a physician, provides false information or commits fraudulent activities in order to obtain compensation to which he or she is not entitled. Any person involved in the workers’ comp process has the potential to try to deceive the system in order to illegally gain some type of benefit. No matter what part of the process, anyone who purposefully commits fraudulence is subject to prosecution. If found guilty, there may be legal and professional consequences.

Nevada Workers Compensation Provider Fraud Defined

A physician or other medical caregiver may try to illegally obtain benefits from workers’ comp in several ways:

  • • By providing extra services that are unnecessary
  • • By charging more for services than normal
  • • By charging for services that are never provided

Other Types of Workers Compensation Fraud

In Nevada, other individuals in the workers’ comp process may also be prosecuted for fraudulent activity if that person purposefully intends to use fraudulence in order to obtain compensation or benefits to which that individual is not entitled.

The applicant / claimant may fake or lie about an injury in order to qualify for workers compensation benefits.

The employer may provide false information on number of employees and their duties in order to pay less for or avoid carrying the insurance, or they may remove premiums from employee paychecks.

The insurance carrier may lie to reduce employee eligibility and thus compensation benefits.

Claims mills, typically consisting of attorneys, doctors, and other relevant worker, find ways to file false claims to obtain benefits illegally.

Prosecution of Provider Fraud

The Nevada’s Department of Business and Industry oversees claims and distribution regarding workers’ comp benefits. When fraudulence occurs, the Workers Compensation Unit of the Nevada Attorney General’s Office prosecutes these cases. Not only is the individual accused of fraudulence able to be prosecuted, but any other individual who helps in the fraudulent activity.

Federal Laws regarding Provider Fraud

Federal workers have its own workers’ comp program called the Federal Employees’ Compensation Act (FECA). The United States government manages FECA and any fraudulence against FECA is considered to be a federal offense and will be prosecuted as such.

Defense to Nevada Workers Comp Provider Fraud

Those who are accused of fraudulent activities against workers compensation may not have meant to commit fraudulence against the system. There are several defenses that may be used to prove that no fraudulent activity occurred.

No intent to defraud is a defense that can be used if the medical caregiver did not purposefully intend to deceive or use fraudulent activity. An example of that would be if imaging results were mixed up at the facility that performed the test, and the physician provided treatment based on the records received. Although additional unnecessary services might have been provided and billed to workers’ comp, the physician did not intentionally try to use deceit to illegally obtain benefits.

False accusations can occur if one of the other parties involved in the workers’ comp process lies or mistakenly believes that the medical care provider acted fraudulently in the claim. This often occurs when another party is committing fraudulent activity and tries to place the blame on someone else to try to avoid getting caught.

Police misconduct may also occur in the gathering of evidence for prosecution. If proper procedure was not followed, such as with an illegal search, any evidence obtained not following those procedures can be dismissed from the prosecution’s case. This often results in a dismissal if the only evidence was gained through police misconduct.

Penalties for Nevada Workers Comp Provider Fraud

If a provider is found guilty of fraudulent activity regarding workers’ comp, there are legal and professional punishments that the physician or other medical caregiver may face.

Nevada. Punishments may include time in prison of 1 – 4 years, a fine that could be up to $5,000, reimbursement of any benefits received from workers’ comp, payment of restitution, and even the suspension or revocation of any professional licenses that are held by the medical provider.

Federal. Federal punishments are similar, with imprisonment in a federal prison of up to 5 years and a fine of up to $10,000.

Legal Resources for Nevada Workers Compensation Fraud

If you need assistance or more information, the Morris / Anderson Law Firm is available to help you. A qualified attorney can help with every step of the workers’ comp process, from filing the initial paperwork to helping you with a case for any hearings that are necessary. Avoid potential legal consequences with the right legal assistance from the Morris / Anderson Law Firm.

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