§ 97-88.2. Penalty for fraud. - North Carolina Statutes

§ 97‑88.2.  Penalty forfraud.

(a)        Any person whowillfully makes a false statement or representation of a material fact for thepurpose of obtaining or denying any benefit or payment, or assisting another toobtain or deny any benefit or payment under this Article, shall be guilty of aClass 1 misdemeanor if the amount at issue is less than one thousand dollars($1,000). Violation of this section is a Class H felony if the amount at issueis one thousand dollars ($1,000) or more. The court may order restitution.

(a1)      When a person isconvicted under subsection (a) of this section, the Commission may enter suchorders as necessary to ensure that the person convicted does not benefit fromthe unlawful conduct.

(b)        The Commissionshall:

(1)        Perform investigationsregarding all cases of suspected fraud and all violations related to workers'compensation claims, by or against insurers or self‑funded employers, andrefer possible criminal violations to the appropriate prosecutorialauthorities;

(2)        Conduct administrativeviolation proceedings; and

(3)        Assess and collectcivil penalties and restitution.

The Commission may employsworn law enforcement officers duly appointed and certified through the NorthCarolina Criminal Justice Education and Training Standards Commission toconduct the investigations mandated by this subsection.

(c)        Any person whothreatens an employee with criminal prosecution under the provisions ofsubsection (a) of this section for the purpose of coercing or attempting tocoerce the employee into agreeing to compensation or agreeing to forgocompensation under this Article shall be guilty of a Class H felony.

(d)        The Commissionshall not be liable in a civil action for any action made in good faith underthis section, including the identification and referral of a person forinvestigation and prosecution for an alleged administrative violation orcriminal offense. Any person, including, but not limited to, an attorney, anemployee, an employer, an insurer, and an employee of an insurer, who in goodfaith comes forward with information under this section, shall not be liable ina civil action.

(e)        The Commissionshall report annually to the General Assembly on the number and disposition ofinvestigations involving claimants, employers, insurance company officials,officials of third‑party administrators, insurance agents, attorneys,health care providers, and vocational rehabilitation providers. (1993 (Reg. Sess., 1994), c.679, s. 7.1; 1995, c. 507, s. 25(a); 1997‑353, s. 1; 2005‑448, s.8; 2007‑358, s. 1.)