Nevada Revised Statutes
Chapter 422 - Health Care Financing and Policy
NRS 422.540 - Offenses regarding false claims, statements or representations; penalties.


1. A person, with the intent to defraud, commits an offense if with respect to the Plan the person:
(a) Makes a claim or causes it to be made, knowing the claim to be false, in whole or in part, by commission or omission;
(b) Makes or causes to be made a statement or representation for use in obtaining or seeking to obtain authorization to provide specific goods or services, knowing the statement or representation to be false, in whole or in part, by commission or omission;
(c) Makes or causes to be made a statement or representation for use by another in obtaining goods or services pursuant to the Plan, knowing the statement or representation to be false, in whole or in part, by commission or omission; or
(d) Makes or causes to be made a statement or representation for use in qualifying as a provider, knowing the statement or representation to be false, in whole or in part, by commission or omission.
2. A person who commits an offense described in subsection 1 shall be punished for a:
(a) Category D felony, as provided in NRS 193.130, if the amount of the claim or the value of the goods or services obtained or sought to be obtained was greater than or equal to $650.
(b) Misdemeanor if the amount of the claim or the value of the goods or services obtained or sought to be obtained was less than $650.
Amounts involved in separate violations of this section committed pursuant to a scheme or continuing course of conduct may be aggregated in determining the punishment.
3. In addition to any other penalty for a violation of the commission of an offense described in subsection 1, the court shall order the person to pay restitution.
(Added to NRS by 1991, 1049; A 1997, 457; 2011, 174)

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Structure Nevada Revised Statutes

Nevada Revised Statutes

Chapter 422 - Health Care Financing and Policy

NRS 422.001 - Definitions.

NRS 422.003 - "Administrator" defined.

NRS 422.021 - "Children’s Health Insurance Program" defined.

NRS 422.030 - "Department" defined.

NRS 422.040 - "Director" defined.

NRS 422.041 - "Division" defined.

NRS 422.046 - "Medicaid" defined.

NRS 422.050 - "Public assistance" defined.

NRS 422.054 - "Undivided estate" defined.

NRS 422.061 - Purposes of Division.

NRS 422.063 - State plans for certain programs: Development, adoption and revision by Director; Division required to comply.

NRS 422.064 - State plans for certain programs: Priority access to treatment and services for certain parents.

NRS 422.065 - Eligibility of persons who are not citizens or nationals of United States for state or local public benefits.

NRS 422.075 - Division to submit certain information to Nevada Commission on Autism Spectrum Disorders.

NRS 422.151 - Creation; function.

NRS 422.153 - Composition; terms and compensation of members.

NRS 422.155 - Chair; Secretary; meetings; subcommittees.

NRS 422.162 - Creation; appointment of members; terms; Chair; members serve without additional compensation; member who is state employee must be relieved from duties to prepare for and attend meetings.

NRS 422.165 - Duties.

NRS 422.175 - "Reinvestment advisory committee" defined. [Effective January 1, 2022.]

NRS 422.185 - Establishment; membership; members serve without compensation; leave for members who are public employees. [Effective January 1, 2022.]

NRS 422.195 - Chair; meetings; subcommittees; quorum. [Effective January 1, 2022.]

NRS 422.205 - Duties; report. [Effective January 1, 2022.]

NRS 422.2354 - Qualifications.

NRS 422.2356 - Executive Officer of Division; administration and management of Division.

NRS 422.2357 - Administration of chapter.

NRS 422.2358 - Reports.

NRS 422.2362 - Fiscal duties.

NRS 422.2364 - Organization of Division; appointment of heads of sections; employees; standards of service.

NRS 422.2366 - Administration of oaths; testimony of witnesses; subpoenas.

NRS 422.2368 - Adoption of regulations.

NRS 422.23685 - Regulations required to include provision prohibiting certain actions relating to organ transplants for persons with disabilities.

NRS 422.2369 - Procedure for adopting, amending or repealing regulations.

NRS 422.2372 - General and miscellaneous powers and duties. [Effective through December 31, 2025.] General and miscellaneous powers and duties. [Effective January 1, 2026.]

NRS 422.2374 - Cooperation with Medicaid Fraud Control Unit; suspension or exclusion of provider of goods or services under State Plan for Medicaid.

NRS 422.239 - Appointment by Division in unclassified service or as contractor; qualifications; duties; restrictions on other employment.

NRS 422.240 - Legislative appropriations; disbursements.

NRS 422.242 - Gifts and grants of money to Division: Deposit in Gift and Cooperative Account of the Division of Health Care Financing and Policy; use; approval of claims by Administrator.

NRS 422.260 - Acceptance of Social Security Act and related federal money.

NRS 422.265 - Acceptance of increased benefits of future congressional legislation; regulations.

NRS 422.267 - Contract or agreement with Federal Government by Director.

NRS 422.270 - Duties of Department regarding Medicaid and Children’s Health Insurance Program.

NRS 422.2703 - Department required to establish and maintain system for electronic submission of applications for Medicaid or Children’s Health Insurance Program.

NRS 422.2704 - Review of and recommendations concerning rates of reimbursement.

NRS 422.2712 - Reporting of certain rates of reimbursement for physicians.

NRS 422.2717 - State Plan for Medicaid: Inclusion of requirement that independent foster care adolescents are eligible for Medicaid.

NRS 422.27171 - State Plan for Medicaid: Inclusion of authorization for pregnant women determined to be presumptively eligible for Medicaid to enroll in Medicaid for prescribed period without submitting application for enrollment which includes addit...

NRS 422.27172 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to family planning. [Effective through December 31, 2021.] State Plan for Medicaid: Inclusion of requirement for payment of certain costs related t...

NRS 422.27173 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for examination of pregnant women for discovery of chlamydia trachomatis, gonorrhea, hepatitis B, hepatitis C and syphilis.

NRS 422.27174 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for preventative care.

NRS 422.27175 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women. [Effective January 1, 2022.]

NRS 422.27176 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for mammogram.

NRS 422.27177 - State Plan for Medicaid: Inclusion of requirement for payment of costs incurred for doula services provided by enrolled doula; application for waiver or amendment related to doula services; requirements for enrollment as doula. [Effec...

NRS 422.27178 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies and prenatal screenings and tests.

NRS 422.27179 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for breastfeeding supplies for certain period, prenatal screenings and tests and lactation consultation and support. [Effective January 1, 2022.]

NRS 422.2718 - State Plan for Medicaid: Inclusion of requirement for payment of certain expenses related to testing for human papillomavirus and administration of human papillomavirus vaccine.

NRS 422.2719 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to fetal alcohol spectrum disorders.

NRS 422.272 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for medical, administrative and transactional costs of certain persons admitted to certain medical facilities for more than 30 days.

NRS 422.2721 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided through telehealth; inclusion of prohibition against certain practices related to such services. [Effective through 1 year after the d...

NRS 422.2722 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for services provided by community health worker.

NRS 422.2723 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to dialysis and emergency care to treat kidney failure.

NRS 422.27234 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to sickle cell disease and its variants.

NRS 422.27235 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs related to preventing acquisition of human immunodeficiency virus.

NRS 422.27236 - State Plan for Medicaid: Inclusion of requirement for payment of certain costs for cognitive assessment and care planning services for persons who experience signs or symptoms of cognitive impairment.

NRS 422.27238 - State Plan for Medicaid: Reimbursement for crisis stabilization services.

NRS 422.27239 - State Plan for Medicaid: Reimbursement of supervising psychologist for services of psychological assistant, psychological intern or psychological trainee.

NRS 422.2724 - State Plan for Medicaid: Reimbursement of registered nurse for certain services provided to persons eligible for Medicaid.

NRS 422.272405 - State Plan for Medicaid: Reimbursement for services provided by advanced practice registered nurse to certain recipients. [Effective January 1, 2022.]

NRS 422.272407 - State Plan for Medicaid: Reimbursement of recipients for personal care services.

NRS 422.27241 - State Plan for Medicaid: Reimbursement for services for hospice care provided to persons eligible for Medicaid.

NRS 422.27242 - State Plan for Medicaid and Children’s Health Insurance Program: Inclusion of authorization for enrollment of certain children; authority to reduce or eliminate available benefits.

NRS 422.27243 - Program to provide medical assistance to certain persons who are employed and have disabilities.

NRS 422.27247 - Application for federal waiver to provide certain dental care for certain persons.

NRS 422.27248 - Application for federal waiver authorizing Department to receive federal funding for coverage for certain treatment for person in institution for mental diseases.

NRS 422.273 - Establishment, development and implementation of Medicaid managed care program. [Effective through December 31, 2025.] Establishment, development and implementation of statewide Medicaid managed care program; statewide procurement proce...

NRS 422.2734 - Plan to ensure provision of behavioral health services by certain managed care organizations in culturally competent manner: Preparation; contents; implementation; review; additional duties.

NRS 422.2735 - Program to provide increased capitation payments to Medicaid managed care plans for ground emergency medical transportation services provided by governmental provider. [Effective on the date that a program to provide increased capitati...

NRS 422.2748 - Cooperation with Medicaid Fraud Control Unit.

NRS 422.27482 - Report concerning provision of health benefits by large employers.

NRS 422.27485 - Enrollment of eligible Indian children in Children’s Health Insurance Program: Duty of Department to seek assistance of and cooperate with Indian tribes; immediate action required; certain contracts for provision of services required.

NRS 422.27487 - Eligibility for and coverage under Medicaid for persons who are incarcerated and persons released from incarceration; regulations. [Effective January 1, 2022.]

NRS 422.2749 - Custody, use, preservation and confidentiality of records, files and communications concerning applicants for and recipients of public assistance or assistance pursuant to Children’s Health Insurance Program; regulations.

NRS 422.27495 - Contracts for provision of certain transportation services for recipients of Medicaid and recipients of services pursuant to Children’s Health Insurance Program; regulations.

NRS 422.27497 - Establishment of certain rates of reimbursement and limitations on hours for provision of certain services for recipients of Medicaid by behavior analysts, assistant behavior analysts and registered behavior technicians; reporting of...

NRS 422.275 - Legal advisers for Division.

NRS 422.276 - Appeal to Division by applicant for or recipient of benefits from Medicaid or Children’s Health Insurance Program; notice of initial decision; hearing.

NRS 422.277 - Hearing: Rights of parties; informal disposition; record; transcribing of oral proceedings; findings of fact; certain employees or representatives of Division prohibited from participating in decision.

NRS 422.2775 - Hearing: Evidence.

NRS 422.278 - Hearing: Person with communications disability entitled to services of interpreter.

NRS 422.2785 - Contents and delivery of decision or order of hearing officer; petition for judicial review; filing of decision and record with court.

NRS 422.279 - Judicial review: Taking of additional evidence; limitations on review; grounds for reversal; appeal to appellate court.

NRS 422.280 - Forms of reports and records to be kept by persons subject to supervision or investigation by Division.

NRS 422.291 - Assistance not assignable or subject to process or bankruptcy law.

NRS 422.292 - Assistance subject to future amending and repealing acts.

NRS 422.293 - Subrogation: Department subrogated to rights of recipient of Medicaid or of insurance provided pursuant to Children’s Health Insurance Program; lien on proceeds of recovery.

NRS 422.293001 - Subrogation: Notice to Department of recipient’s claim; statute of limitations tolled until notice received.

NRS 422.293003 - Subrogation: Department required to provide notice of amount of lien; enforceability of lien.

NRS 422.293005 - Subrogation: Liability for failure to comply with provisions.

NRS 422.29301 - Administration of provisions concerning recovery of amounts incorrectly paid for recipient of Medicaid; regulations; enforcement.

NRS 422.29302 - Recovery of benefits paid for Medicaid: Powers and duties of Department; claim against estate of recipient; regulations; distribution of money recovered; payment in cash.

NRS 422.29304 - Recovery of amounts paid for Medicaid under certain circumstances; powers and duties of Department; duty to reimburse Department; waiver of repayment; regulations.

NRS 422.29306 - Imposition and release of lien on property of recipient of Medicaid.

NRS 422.305 - Confidentiality of information obtained in investigation of provider of services under State Plan for Medicaid.

NRS 422.306 - Hearing to review action taken against provider of services under State Plan for Medicaid; regulations; appeal of final decision.

NRS 422.308 - Family planning service; birth control.

NRS 422.3085 - Development of Sexual Trauma Services Guide; provision of information about Guide to public; regulations.

NRS 422.309 - Provision of prenatal care to pregnant women who are indigent; provision of information concerning availability of prenatal care; regulations.

NRS 422.361 - Definitions.

NRS 422.362 - "Cardholder" defined.

NRS 422.363 - "Medicaid card" defined.

NRS 422.364 - "Plan" defined.

NRS 422.365 - "Receives" defined.

NRS 422.366 - Unlawful acts: Obtaining or possessing card without consent of holder of card; presumption from possession of card; penalty.

NRS 422.367 - Unlawful acts: Sale or purchase of card; authorization by holder of card for use by person not entitled to use card; penalty.

NRS 422.368 - Unlawful acts: Use of forged, expired or revoked card to obtain benefits; receipt of benefits by misrepresentation; penalty.

NRS 422.369 - Unlawful acts: Fraud by person authorized to provide care to holder of card; penalty.

NRS 422.3755 - Definitions.

NRS 422.376 - "Facility for intermediate care" defined.

NRS 422.3765 - "Facility for skilled nursing" defined.

NRS 422.3771 - "Nursing facility" defined.

NRS 422.3775 - Fee: Payment; amount; due date; allowable cost for Medicaid reimbursement purposes.

NRS 422.378 - Report by nursing facility to Division.

NRS 422.3785 - Account to Increase the Quality of Nursing Care: Creation; deposit of money; expenditures; consequence of federal law prohibiting certain expenditures from Account.

NRS 422.379 - Administrative penalties for late payment of fee; recoupment of fees and administrative penalties; repayment plan.

NRS 422.3791 - Definitions.

NRS 422.37915 - "Account" defined.

NRS 422.3792 - "Agency to provide personal care services in the home" defined.

NRS 422.37925 - "Medical facility" defined.

NRS 422.3793 - "Operator" defined.

NRS 422.37935 - "Operator group" defined.

NRS 422.3794 - Imposition of assessment; vote; amount of assessment; regulations; deposit of revenue; compliance with federal law; submission of information to Division.

NRS 422.37945 - Account to Improve Health Care Quality and Access: Creation; administration; separate accounting; uses; nonreversion.

NRS 422.3795 - Administrative penalties; deduction from future Medicaid payments; notification; payment plans.

NRS 422.380 - Definitions.

NRS 422.3805 - Federal waivers: Duties of Administrator.

NRS 422.382 - Intergovernmental transfers of money from counties to Division; deposit in Intergovernmental Transfer Account in State General Fund; administration by Division.

NRS 422.385 - Disproportionate share payments from Medicaid Budget Account; transfer of money from Intergovernmental Transfer Account.

NRS 422.387 - Calculation of disproportionate share payments; verification of eligibility for disproportionate share payments; Director authorized to negotiate terms of amendment to State Plan for Medicaid with Centers for Medicare and Medicaid Servi...

NRS 422.390 - Regulations; quarterly report.

NRS 422.396 - Establishment and administration of program to provide community-based services; application for federal waiver to amend State Plan for Medicaid; contracting for services; adoption of regulations.

NRS 422.3962 - Amendment of home and community-based services waiver to include as medical assistance under Medicaid funding of assisted living supportive services for senior citizens who reside in certain assisted living facilities.

NRS 422.3964 - State Plan for Medicaid: Inclusion of certain home and community-based services.

NRS 422.398 - Prohibition against considering money deposited in individual development account by recipient of Medicaid to be income for certain purposes. [Effective January 1, 2022.]

NRS 422.399 - Instruction in financial literacy for certain recipients of Medicaid. [Effective January 1, 2022.]

NRS 422.401 - Definitions.

NRS 422.4015 - "Board" defined.

NRS 422.402 - "Drug Use Review Board" defined.

NRS 422.4021 - Health benefit plan" defined.

NRS 422.4022 - "Health maintenance organization" defined.

NRS 422.4023 - "Pharmacy benefit manager" defined.

NRS 422.4024 - "Sickle cell disease and its variants" defined.

NRS 422.4025 - List of preferred prescription drugs used for Medicaid program and Children’s Health Insurance Program; list of drugs excluded from restrictions; role of Pharmacy and Therapeutics Committee; availability of new pharmaceutical products...

NRS 422.4026 - Coverage of certain supplements for treating sickle cell disease and its variants: Adoption of list by regulation; periodic review of list.

NRS 422.403 - Establishment and management of use by Medicaid program of step therapy and prior authorization; duties of Drug Use Review Board; acceptance of recommendations from Board; regulations.

NRS 422.4032 - Exemption from required step therapy for certain drugs: Application process; form; approval; payment of cost of drug for which exemption applies. [Effective January 1, 2022.]

NRS 422.4035 - Silver State Scripts Board: Creation; membership.

NRS 422.404 - Silver State Scripts Board: Chair; terms; vacancies; meetings; quorum.

NRS 422.4045 - Silver State Scripts Board: Members serve without compensation; members entitled to per diem; members holding public office or employed by governmental entity.

NRS 422.405 - Silver State Scripts Board: Duties and powers.

NRS 422.4052 - Department to take certain actions relating to acquisition of prescription drugs for recipient of Medicaid who resides in area for which declared disaster or emergency is in effect.

NRS 422.4053 - Department to manage payments and rebates for prescription drugs; contract for provision of certain services.

NRS 422.4056 - Audits of certain contracts; posting of audit results on Internet website.

NRS 422.406 - Regulations; contracts for services.

NRS 422.410 - Fraudulent acts; penalties.

NRS 422.450 - Definitions.

NRS 422.460 - "Benefit" defined.

NRS 422.470 - "Claim" defined.

NRS 422.480 - "Plan" defined.

NRS 422.490 - "Provider" defined.

NRS 422.500 - "Recipient" defined.

NRS 422.510 - "Records" defined.

NRS 422.520 - "Sign" defined.

NRS 422.525 - "Statement or representation" defined.

NRS 422.530 - Responsibility for false claim, statement or representation.

NRS 422.540 - Offenses regarding false claims, statements or representations; penalties.

NRS 422.550 - Statement regarding truth and accuracy of applications, reports and invoices; perjury; presumption concerning person who signs statement on behalf of provider.

NRS 422.560 - Offenses regarding sale, purchase or lease of goods, services, materials or supplies; penalty.

NRS 422.570 - Intentional failure to maintain adequate records; intentional destruction of records; penalties.

NRS 422.580 - Civil penalties for certain violations; liability of provider for excess amount unknowingly accepted; enforcement; use of money collected as penalty or repayment.

NRS 422.590 - Limitation and accrual of actions.