Mealey's Insurance Fraud

  • November 22, 2017

    $1.5M Settlement Reached In False Claims Dispute Over Substandard Nursing Home Care

    JACKSON, Miss. — The operators of a Mississippi nursing home have agreed to pay the United States a total of $1.25 million to resolve allegations that they provided false claims to Medicare and the Mississippi Medicaid program related to the provision of “grossly substandard care” to residents, the U.S. Department of Justice announced Nov. 16.  The same day, a Mississippi federal judge dismissed a relator’s second amended complaint and the United States’ complaint in intervention in the qui tam action after the parties stipulated to dismissal (United States, ex rel., Academy Health Center Inc. v. Hyperion Foundation Inc., et al., No. 10-00552, S.D. Miss.).

  • November 15, 2017

    Doctor Sentenced To 5 Years In Prison For Fraud, Money-Laundering Scheme

    MIAMI — A federal judge in Florida on Nov. 8 sentenced a doctor to five years in prison and ordered him to pay $2.1 million in restitution for his role in an health care fraud and money-laundering scheme that involved the filing of fraudulent insurance claim forms and defrauding health care benefit programs (United States of America v. Kenneth Chatman, et al., No. 17cr80013, S.D. Fla.).

  • November 15, 2017

    Woman Convicted For Role In $3.2M Kickback Scheme To Provide Medical Equipment

    NEW ORLEANS  — A federal judge in Louisiana on Nov. 8 found a woman guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks, two counts of health care fraud and five counts of accepting kickbacks for her role in a $3.2 million scheme that involved providing durable medical equipment to Medicare beneficiaries that was medically unnecessary (United States of America v. Tracy Richardson Brown, et al., No. 13-cr-243, E.D. La.).

  • November 15, 2017

    State Farm Can Pursue Trade Practices Claims Over Billing Scheme, Judge Says

    MIAMI — State Farm Mutual Automobile Insurance Co. can pursue claims under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) against medical facilities accused of participating in a fraudulent billing scheme that caused the insurer to incur damages exceeding $3.8 million, a federal judge in Florida ruled Sept. 25, ruling that State Farm sufficiently stated claims for relief under the act (State Farm Mutual Automobile Insurance Company v. Performance Orthopaedics & Neurosurgery, LLC, et al., No. 17-cv-20028-KMM, S.D. Fla., 2017 U.S. Dist. LEXIS 156284).

  • November 14, 2017

    Intervenor’s Request To Amend Pleadings Against Insurer Untimely, Judge Says

    GREENBELT, Md. — An intervening party in an insurance company’s lawsuit accusing an insured of making material misrepresentations on a policy application cannot amend its pleadings to change admissions and add counterclaims, a federal judge in Maryland ruled Nov. 13, finding that the request was untimely (CX Insurance Company v. Benjamin L. Kirson, No. 15-cv-3132, D. Md., 2017 U.S. Dist. LEXIS 187164).

  • November 10, 2017

    Doctor Sentenced To 15 Years, Ordered To Pay $9.1 M For Fraud Scheme

    DETROIT — A doctor was sentenced to 15 years in prison and ordered to pay $9.1 million in restitution by a federal judge in Michigan on Nov. 8 after being found guilty for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided (United States of America v. John Trotter II, et al., No. 14cr20273, E.D. Mich.).

  • November 10, 2017

    Fabricated Authorization Letter Constituted Fraud, Pennsylvania Appeals Court Finds

    PITTSBURGH — A woman was properly convicted for insurance fraud, forgery and theft of property, a Pennsylvania appeals panel ruled Nov. 7, finding that the woman’s presentation of a fabricated authorization letter for dental work constituted an attempt to defraud her insurance company (Commonwealth of Pennsylvania v. Amy Lee Palmer, No. 1039 WDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4117).

  • November 10, 2017

    Pennsylvania Panel Upholds Woman’s Conviction, Sentence For Insurance Fraud

    PHILADELPHIA — A Pennsylvania appeals panel on Nov. 7 overruled a woman’s argument that evidence presented during her insurance fraud trial did not support her conviction, holding that the state sufficiently showed an intent to defraud through her false statements to a state trooper during the investigation of a car fire (Commonwealth of Pennsylvania v. Ruth E. Gettel, No. 533 MDA 2017, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4101).

  • November 9, 2017

    Evidence Supported Convictions For Fraud, Kickback Charges, 5th Circuit Says

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 7 upheld convictions of a man and his son who were accused of health care fraud and paying kickbacks to obtain business for their partial hospitalization programs (PHPs), ruling that evidence presented by the government was sufficient to support the jury’s verdict (United States of America v. Earnest Gibson III, et al., No. 15-20323, 5th Cir., 2017 U.S. Dist. LEXIS 22261).

  • November 7, 2017

    Judge: Antagonistic Defenses Do Not Warrant Severing Insurance Fraud Defendants

    NEW YORK — A federal judge in New York on Nov. 3 denied motions filed by two doctors seeking to sever their claims from a criminal insurance fraud indictment, finding that the defendants’ antagonistic defenses and the possibility of prejudicial spillover did not warrant severance (United States of America v. Asim Hameedi, et al., No. 17 Cr. 137, S.D. N.Y., 2017 U.S. Dist. LEXIS 182790).

  • November 3, 2017

    2 California Residents Sentenced Over $38M Insurance Fraud Scheme

    NEW ORLEANS — Two California residents who owned and operated a medical equipment store were sentenced by a federal judge in Louisiana on Nov. 2 for their roles in a $38 million fraud scheme centering around the distribution of talking glucose meters that were not medically needed and were often not even requested (United States of America v. Geoffrey Ricketts, et al., No. 15cr153, E.D. La.).

  • November 1, 2017

    4th Circuit: Judge Properly Addressed Materiality Of Couple’s Misrepresentations

    RICHMOND, Va. — A Fourth Circuit U.S. Court of Appeals panel on Oct. 30 affirmed a federal judge in Virginia’s decisions finding a couple guilty of conspiring to commit health care fraud and denying their post-trial motions for acquittal, holding that the judge properly addressed whether misrepresentations the defendants made to insurers were material (United States of America v. Beth Palin, et al., Nos. 16-4522, 16-4540, 4th Cir., 2017 U.S. App. LEXIS 21596).

  • October 31, 2017

    Judge Adopts Recommendation To Deny Motion To Dismiss Fraud Indictment

    MINNEAPOLIS — A federal judge in Minnesota on Oct. 25 adopted a magistrate judge’s Sept. 8 recommendation to deny an insurance fraud defendant’s motion to dismiss a two-count indictment accusing him of submitting false bills from his chiropractic firm to insurers (United States of America v. Timothy Wayne Guthman, No. 17-67, D. Minn., 2017 U.S. Dist. LEXIS 177656).

  • October 31, 2017

    Pennsylvania Panel Upholds Insurance Fraud Sentence, Allows Counsel To Withdraw

    PHILADELPHIA — A Pennsylvania Superior Court panel on Oct. 27 affirmed a man’s sentence of nine to 23 months in prison for insurance fraud and receiving stolen goods and allowed the man’s attorney to withdraw from the case (Commonwealth of Pennsylvania v. Tracy Martin, No. 3789 EDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4013).

  • October 31, 2017

    Health Care Fraud Defendant Ordered To Pay $847,016 In Restitution

    BOISE, Idaho — A federal judge in Idaho on Oct. 27 ordered a dentist to pay $847,016 in restitution and forfeit $139,769.80 after pleading guilty to 24 counts of health care fraud (United States of America v. Cherie Renee Dillon, No. 16-cr-0037, D. Idaho, 2017 U.S. Dist. LEXIS 178810).

  • October 31, 2017

    Judge Refuses To Allow Insurance Fraud Defendant To Withdraw Guilty Plea

    CLEVELAND — A chiropractor who pleaded guilty to conspiracy to commit health care fraud, health care fraud, conspiracy to commit money laundering and wire fraud cannot withdraw his plea, a federal judge in Ohio ruled Oct. 19, finding that the request was untimely (United States of America v. John Fortuna, No. 14cr447, N.D. Ohio, 2017 U.S. Dist. LEXIS 173297).

  • October 27, 2017

    Federal Judge Finds Oregon Waived Sovereign Immunity From Coverage Case

    PORTLAND, Ore. — After finding that the state of Oregon waived its right to sovereign immunity in an action brought by an insurer that seeks to have an environmental policy voided based on alleged misrepresentations made by the insureds, an Oregon federal judge on Oct. 17 adopted a magistrate judge’s recommendation to grant the state’s motion to intervene (United Specialty Insurance Co. v. Clay Jonak, et al., No. 3:17-cv-00330, D. Ore., 2017 U.S. Dist. LEXIS 172150).

  • October 26, 2017

    Doctor Pleads Guilty To Opioid Health Care Fraud, Taking Kickbacks From Insys

    PROVIDENCE, R.I. — A Rhode Island doctor on Oct. 25 pleaded guilty to health care fraud and taking kickbacks for prescribing the opioid Subsys to unqualified patients (United States of America v. Jerrold N. Rosenberg, No. 17-9, D. R.I.).

  • October 24, 2017

    Appeals Court: Judge Erred When Resentencing Woman For Insurance Fraud

    DAYTON, Ohio — An Ohio appeals panel on Oct. 20 overturned a trial court judge’s ruling that resentenced a woman on one count of insurance fraud, holding that the judge should have found that the sentence would run concurrently with, rather than consecutive to, other charges (State of Ohio v. Eva Christian, No. 27236, Ohio App., 2nd Dist., 2017 Ohio App. LEXIS 4641).

  • October 20, 2017

    Parties Announce $5M Settlement In False Claims Act Lawsuit Against Nursing Home

    HOUSTON — The United States of America, the state of Texas, a whistleblower, a nursing home and its parent company on Oct. 6 filed a joint stipulation of dismissal of claims alleging that the nursing home conducted a scheme to bill Medicare and Texas Medicaid to obtain payment for services that were never provided or were so deficient that they harmed patients and were “essentially worthless” (United States and Texas ex rel. Susan Anthony v. Health Services Management, Inc., et al., No. 15-2291, S.D. Texas).