Mealey's Insurance Fraud

  • March 27, 2017

    Appeals Court: Grand Jury Proceedings, Evidence Supported Arson Fraud Verdict

    CLEVELAND — An Ohio appeals court on March 23 affirmed a man’s conviction for three counts of aggravated arson and one count of insurance fraud after overruling the defendant’s argument that he was prejudiced by grand jury proceedings that involved the use of a Bureau of Alcohol, Tobacco and Firearms (ATF) agent who later found that the cause of the fire was undetermined and that the evidence presented during trial sufficiently supported the jury’s finding (State of Ohio v. Dale Rodano, No. 104176, Ohio App., 8th Dist., 2017 Ohio App. LEXIS 1009).

  • March 24, 2017

    California Appeals Panel Affirms Insurer’s Restitution Award In Fraud Suit

    SAN DIEGO — An insurer is entitled to $37,000 in restitution from a man who pleaded guilty to misrepresenting to the company that nurses he sent to work at skilled-nursing facilities were computer programmers to obtain a lower workers’ compensation policy premium, a California appeals panel ruled March 22 in affirming the man’s conviction (People v. John Paul Riddles, No. D069419, Calif. App., 4th Dist., 1st Div., 2017 Calif. App. LEXIS 259).

  • March 21, 2017

    Judge: Insurers Have No Duty To Defend After Policy Holders Plead Guilty

    KNOXVILLE, Tenn. — Two insurance companies were awarded summary judgment by a federal judge in Tennessee on March 15, after the judge found that policy holders’ guilty pleas to charges of insurance fraud and conspiracy to commit insurance fraud removed any obligations the companies had to pay for claims stemming from an August 2013 fire (State Automobile Mutual Insurance Company v. Fireman Fire Protection Inc., et al., No. 14-cv-229-TAV-HGB, E.D. Tenn., 2017 U.S. Dist. LEXIS 36704).

  • March 21, 2017

    4th Circuit Reinstates Retaliation Claim In Suit Over Overbilling Clinics

    RICHMOND, Va. — A federal judge in Virginia erred in finding that a physical therapist assistant’s retaliation claim against his employer should be dismissed, finding that they were not subject to the False Claims Act’s (FCA) first-to-file rule, a Fourth Circuit Court of Appeals ruled March 16, but affirmed the dismissal of his qui tam claims under the statute (United States of America, ex rel. Patrick Gerard Carson v. Manor Care, Inc., a./k/a Manor Care, Inc., et al., No. 16-1035, 4th Cir., 2017 U.S. App. LEXIS 4617).

  • March 15, 2017

    Pennsylvania Woman Pleads Guilty To Health Care Fraud Scheme

    HARRISBURG, Pa. — A Pennsylvania woman on March 8 pleaded guilty to one count of health care fraud for her role in a scheme that resulted in Medicaid paying $84,500 for services she provided (United States of America v. Tammie Sensenig, No. 17cr0043, M.D. Pa.).

  • March 15, 2017

    Man Pleads Guilty To Conspiring To Pay Kickbacks To TRICARE Beneficiaries

    TAMPA, Fla.  — A sales representative for a Florida marketing firm on March 7 pleaded guilty in Florida federal court to one count of conspiring to defraud the United States for his participation in a scheme involving the payment of kickbacks to beneficiaries of TRICARE, which provides health benefits for U.S. Armed Forces personnel, for the purchase of compounded medications to treat pain and scars (United States of America v. Cordera Hill, et al., No. 16-cr-436, MD. Fla.).

  • March 13, 2017

    Judge Finds Evidence Supported Verdict Finding Man Set Fire For Insurance

    PROVIDENCE, R.I. — A man’s motion for acquittal from a verdict finding him guilty of setting fire to a restaurant in an attempt to obtain insurance proceeds was denied March 7 by a federal judge in Rhode Island who ruled that the evidence presented by the government during the trial was sufficient to support the verdict (United States of America v. Daniel E. Saad, No. 16-cr-35, D. R.I., 2017 U.S. Dist. LEXIS 33441).

  • March 10, 2017

    Judge Grants Motion To Compel Admissions From Chiropractor Accused Of Fraud

    SEATTLE — A federal judge in Washington on March 7 ordered a chiropractor and his practice to submit better responses to State Farm Mutual Automobile Insurance Co.’s requests for information regarding treatments provided for patients that are subject to an alleged fraudulent billing scheme (State Farm Mutual Automobile Insurance Company v. Peter J. Hanson, P.C. d/b/a Hanson Chiropractic, et al., No. C16-1085RSL, W.D. Wash., 2017 U.S. Dist. LEXIS 32719).

  • March 8, 2017

    Insureds’ Intent To Defraud A Matter For Jury To Decide, Judge Rules

    DETROIT — A jury should determine if an insured couple intended to defraud their insurance company when stating that they had decided to not move to Florida from Michigan to maintain coverage on their vehicle, a federal judge in Michigan ruled March 6 in denying IDS Property Casualty Insurance Co.’s motion for summary judgment (IDS Property Casualty Insurance Company v. David P. Kaisch, et al., No. 15-11566, E.D. Mich., 2017 U.S. Dist. LEXIS 31931).

  • March 7, 2017

    Insurer Can Rescind Auto Insurance Policy Over Misrepresentations, Judge Says

    PORTLAND, Maine — A federal judge in Maine on March 3 granted an insurer’s motion for summary judgment, finding that a man’s material misrepresentations about where he resided and where he garaged the automobiles for which he was seeking coverage warranted rescission of the policy (Dairyland Insurance Company v. McArthur Sullivan, No. 16-cv-00050-JDL, D. Maine, 2017 U.S. Dist. LEXIS 30116).

  • March 7, 2017

    Judge Refuses To Dismiss State Farm’s Suit Alleging No-Fault Insurance Scheme

    DETROIT — A federal judge in Michigan on March 6 denied a motion to dismiss filed by defendants accused by State Farm Mutual Automobile Insurance Co. of submitting false bills under Michigan’s No-Fault Automobile Insurance Act for services that were either medically unnecessary or never provided, ruling that the defendants’ arguments lacked merit (State Farm Mutual Automobile Insurance Company v. Elite Health Centers, Inc., et al., No. 16-13040, E.D. Mich., 2017 U.S. Dist. LEXIS 30826).

  • March 7, 2017

    Man Who Posed As Physician As Part Of Fraud Scheme Found Guilty

    HOUSTON — A man who posed as a physician as part of a $1.3 million Medicare fraud scheme was found guilty on counts of conspiracy to commit health care fraud, health care fraud and conspiracy to pay health care kickbacks by a federal jury in Texas on March 3 (United States of America v. Nkiru Ibeabuchi, et al., No. 16-cr-114, S.D. Texas).

  • March 3, 2017

    Judge Denies Social Security Fraud Defendants’ Requests For Bill Of Particulars

    LEXINGTON, Ky. — A federal judge in Kentucky on Feb. 28 denied requests from two defendants accused of Social Security fraud for a bill of particulars, finding that it was an improper way of seeking itemized evidence from the government (United States of America v. David Black Daugherty, et al., No. 16-cr-22-DCR-REW, E.D. Ky., 2017 U.S. Dist. LEXIS 27496).

  • March 1, 2017

    Home Health Agency Administrator Sentenced To 126 Months For Fraud

    MIAMI — An administrator of a home health agency was sentenced to 126 months in prison by a federal judge in Florida on Feb. 24, after the defendant was found guilty for his role in a $2.5 million Medicare fraud scheme (United States of America v. Raciel Leon, et al., No. 16cr20476, S.D. Fla.).

  • March 1, 2017

    U.S. Attorney: Medical Equipment Company Owner Found Guilty Of Fraud

    McALLEN, Texas — U.S. Attorney Kenneth Magidson on Feb. 24 announced that the owner of a durable medical equipment (DME) company was found guilty by a federal jury in the Southern District of Texas for conspiracy to commit health care fraud, health care fraud, paying illegal kickbacks and other charges in connection with a $2.5 million scheme involving the submission of fraudulent bills to Texas Medicaid.

  • February 28, 2017

    California Panel Upholds Rulings Requiring Man To Repay Unemployment Benefits

    SAN JOSE, Calif. — A California appeals panel on Feb. 24 upheld a trial court’s decision to deny a man’s request for a writ of mandate that would allow him to retain unemployment benefits he received from November 2008 through March 2013, finding that he obtained the benefits through misrepresentations (Abhijit Prasad v. California Unemployment Insurance Appeals Board, No. H041590, Calif. App., 6th Dist., 2017 Calif. App. Unpub. LEXIS 1349).

  • February 27, 2017

    Magistrate Judge: Fraud Defendants Should Pay $2.7M To GEICO Over Scheme

    NEW YORK — A federal magistrate judge in New York on Feb. 22 recommended that a judge enter default judgment against defendants accused by the Government Employees Insurance Company (GEICO) and other insurers of fraud and unjust enrichment for submitting bills from clinics that were not owned by physicians and order them to pay $2.7 million in damages (Government Employees Insurance Co., et al. v. Parkway Medical Care, P.C., et al., No. 15 Civ. 3670, E.D. N.Y., 2017 U.S. Dist. LEXIS 24994).

  • February 23, 2017

    Magistrate Recommends Partial Default Judgment Against 38 Defendants In Scheme

    NEW YORK — A federal magistrate judge in New York on Feb. 15 recommended entering default judgment against 38 defendants accused of fraud and violating the Racketeer Influenced and Corrupt Organizations Act for fraudulently billing Allstate Insurance Co. and other insurance companies for durable medical equipment (DME), but found that the insurers’ claim for unjust enrichment was duplicative of the cause of action for fraud (Allstate Insurance Company, et al. v. Fotima Abutova, et al., No. 13 CV 3494, E.D. N.Y., 2017 U.S. Dist. LEXIS 22670).

  • February 16, 2017

    Magistrate Judge Recommends Entering Default Against Doctor, Clinics For Fraud

    NEW YORK — A federal magistrate judge in New York on Feb. 13 recommended that a federal judge enter default judgment against a doctor and the clinics he owned for common-law fraud and violation of the Racketeer Influenced and Corrupt Organizations Act for his role involving the submission of fraudulent bills and kickbacks for referring patients to doctors for medical procedures that were not necessary (Government Employee Insurance Company v. Roger Jacques, M.D., et al., No. 14 Civ. 5299, E.D. N.Y., 2017 U.S. Dist. LEXIS 20195).

  • February 16, 2017

    Appeals Court: Insurer Can Seek To Deny Coverage Due To Misrepresentation

    DETROIT — A Michigan appeals panel on Jan. 24 reversed a trial court judge’s ruling that an insurance company is required to provide no-fault benefits coverage to an innocent party, finding that the ruling in Bazzi v Sentinel Ins., Co., 2016 Mich. App. LEXIS 1153 (Mich. App. 2016), is still binding precedent (Farm Bureau General Insurance Company of Michigan v. Robert Elzer, et al., No. 329332, Mich. App., 2017 Mich. App. LEXIS 130).