Mealey's Insurance Fraud

  • April 21, 2017

    Judge: Insurer Can Pursue Claims Over Scheme To Reduce Workers’ Comp Premiums

    NEWARK, N.J. — Liberty Mutual Insurance Corp. sufficiently alleged that a roofing company and its owner could be found liable for workers’ compensation fraud and insurance fraud by submitting false information to obtain lower premiums, a federal judge in New Jersey ruled April 5 in denying the defendants’ motion to dismiss (LN Insurance Corporation, et al. v. All-Ply Roofing Co., Inc., et al., No. 14-4723, D. N.J., 2017 U.S. Dist. LEXIS 53127).

  • April 20, 2017

    Magistrate Judge: Insurers Should Receive $2.8M In Attorney Fees

    WHITE PLAINS, N.Y. — A federal magistrate judge in New York on April 14 recommended that insurance companies that prevailed on claims that a former claims adjuster and a contractor violated the Connecticut Unfair Trade Practices Act (CUTPA) by engaging in a scheme to fraudulently inflate estimates to repair damages to properties insured by the plaintiff companies are entitled to $2.8 million in attorney fees and $656,684.36 in costs (Federal Insurance Company, et al. v. Paul H. Mertz Jr., et al., No. 12 Civ. 1597, S.D. N.Y., 2017 U.S. Dist. LEXIS 58458).

  • April 18, 2017

    Judge Refuses To Dismiss State Farm’s Claims Over $3.8M Fraud Scheme

    WEST PALM BEACH, Fla. — A federal judge in Florida on March 30 refused to dismiss a lawsuit brought by State Farm Mutual Automobile Insurance Co. against doctors and clinics accused of engaging in a scheme to submit bills under insureds’ no-fault benefits for medically unnecessary treatments, ruling that it was premature to find that the insurer committed fraud on the court by omitting certain pages from documents it submitted as exhibits to its complaint (State Farm Mutual Automobile Insurance Company v. Gary Brown, et al., No. 16-80793, S.D. Fla., 2017 U.S. Dist. LEXIS 57019).

  • April 18, 2017

    Judge Finds State Farm Has Evidence Of Scheme To Submit False Bills

    ANN ARBOR, Mich. — A federal judge in Michigan on April 10 denied a motion for summary judgment filed by a doctor and his practice, finding that State Farm Mutual Automobile Insurance Co. has sufficient evidence to show that the defendants engaged in a scheme to submit false bills to obtain no-fault benefits State Farm Mutual Automobile Insurance Company v. Louis Radden, D.O., et al., No. 14-cv-13299, E.D. Mich., 2017 U.S. Dist. LEXIS 54093).

  • April 11, 2017

    11th Circuit Finds Group Could Have Investigated Life Expectancy Representations

    ATLANTA — The 11th Circuit U.S. Court of Appeals on April 6 affirmed a district court's ruling that claims asserted by an entity, who alleged that agents made misrepresentations that fraudulently induced it into purchasing existing life insurance policies, were barred by a four-year statute of limitations under Florida law (The Bedtow Group II, LLC v. Martin B. Ungerleider, No. 16-10213, 11th Cir., 2017 U.S. App. LEXIS 5945).

  • April 6, 2017

    Judge Enters Default Judgment Against Doctors, Clinics In Fraud Scheme

    NEW YORK — A federal judge in New York on March 31 adopted a magistrate judge’s recommendation to enter default judgment against doctors and health care clinics accused of submitting fraudulent bills to Government Employees Insurance Co. (GEICO), finding that the recommendation was “well-reasoned, thorough and carefully calculated” (Government Employee Insurance Company v. Roger Jacques, M.D., et al., No. 14 Civ. 5299, E.D. N.Y., 2017 U.S. Dist. LEXIS 50825).

  • March 31, 2017

    Insureds Not Indispensable Parties To GEICO’s Windshield Fraud Suit, Judge Says

    ORLANDO, Fla. — A federal judge in Florida on March 29 denied three motions to dismiss a lawsuit brought by Government Employees Insurance Co. (GEICO) accusing five windshield repair companies and their owners of engaging in a scheme to submit fraudulent claims for repairs, finding that the company’s insureds are not indispensable parties to the action and that the insurer sufficiently stated claims under the Racketeer Influenced Corrupt Organizations Act, Florida Deceptive and Unfair Trade Practices Act (FDUTPA) and fraud (Government Employees Insurance Company v. Clear Vision Windshield Repair, LLC, et al., No. 16-cvc-2077-Orl-28TBS, M.D. Fla., 2017 U.S. Dist. LEXIS 47353).

  • March 28, 2017

    Judge Trims Some Claims Over Billing For Vein Procedures Due To Pleadings

    CHICAGO — A federal judge in Illinois dismissed without prejudice claims from a man that his former employer falsely billed Medicare, Medicaid and other private insurers for endovascular laser therapy (EVLT) procedures that were not medically necessary or done with reused laser fibers, finding that the allegations were not made with the required level of specificity to support his False Claims Act (FCA) allegations (United States of America, ex rel. Constantine Zverev, et al. v. USA Vein Clinics of Chicago, LLC, et al., No. 12 CV 8004, N.D. Ill., 2017 U.S. Dist. LEXIS 43807).

  • March 28, 2017

    Appeals Court Finds Woman Waived Sufficiency-Of-Evidence Argument

    HARRISBURG, Pa. — An appeals court panel in Pennsylvania on March 23 affirmed a woman’s conviction and sentencing for insurance fraud, finding that she waived her argument challenging the sufficiency of the evidence that was presented during trial (Commonwealth of Pennsylvania v. Emma Comer, No. 1520 MDA 2016, Penn. Super., 2017 Pa. Super. Unpub. LEXIS 1100).

  • 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).