False claim for payment: Withholding by insurer of payment to provider of health care; procedure for withholding; appeal.
Nev. Rev. Stat. § 616D.440
in effect1. An insurer may withhold any payment due a provider of health care pursuant to the provisions of chapters 616A to 616D , inclusive, or chapter 617 of NRS, in whole or in part, upon receipt of reliable evidence that the provider of health care knowingly made a false statement or representation or knowingly concealed a material fact to obtain the payment. The insurer may withhold such a payment without first notifying the provider of health care of its intention to do so.
2. The insurer shall, within 5 days after withholding such a payment, send notice of the withholding to the provider of health care by certified mail or electronic transmission. The notice must:
(a) Set forth the factual basis for the withholding, but need not disclose specific information regarding the insurers investigation;
(b) Indicate that the payment is being withheld pursuant to the provisions of this section;
(c) Indicate that the payment is being withheld temporarily, as set forth in subsection 4, and describe the circumstances under which the withholding will be terminated;
(d) Specify the charge submitted by the provider of health care for which the payment is being withheld; and
(e) Notify the provider of health care of the right of the provider of health care to appeal the withholding.
3. A provider of health care may appeal the decision of the insurer to withhold payment to an appeals officer pursuant to NRS 616C.360 .
4. Any payment withheld pursuant to the provisions of this section must be made to the provider of health care if:
(a) The insurer or the Attorney General determines that there is insufficient evidence to prove that the provider of health care knowingly made a false statement or representation or knowingly concealed a material fact to obtain the payment; or
(b) A final judgment or decree was rendered in favor of the provider of health care in a criminal proceeding arising out of the alleged misconduct.
Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-616D.htmlFetched: 10/4/2026