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Mealey's Insurance Fraud

  • July 27, 2021

    Panel Upholds Recalculated Loss Amount In Blow To Fraud Defendant

    CINCINNATI — A federal judge in Michigan did not err in sentencing the owner of a home health care agency convicted of health care fraud to 300 months’ imprisonment and in ordering $20.7 million in restitution, nor in denying him a new trial, the Sixth Circuit U.S. Court of Appeals ruled July 15.

  • July 15, 2021

    Counterclaim Dismissal Ends Insurer’s Fraud Suit Over Inflated Invoices

    PHILADELPHIA — A federal judge in Pennsylvania on July 1 issued a judgment dismissing with prejudice an auto repair shop’s bad faith counterclaim in an insurance fraud dispute alleging that the repair shop inflated replacement costs for inventory damaged by water, bringing a close to the lawsuit.

  • July 15, 2021

    Arbitration Request In False Claims Act Suit Frivolous, Relators Say

    GULFPORT, Miss. — A federal judge in Mississippi should deny an insurer’s motion to compel arbitration of claims under the False Claims Act (FCA) and stay all proceedings in relators’ 15-year-old qui tam suit accusing the insurer of filing false flood insurance claims after Hurricane Katrina because the motion is frivolous and the insurer failed to address “obvious issues” in its motion, waiting instead to address them in a forthcoming reply brief, the relators argue in a May 27 opposition brief.

  • July 15, 2021

    Judge: Fraud And RICO Claims Against Chiropractors Raise Fact Issues For Jury

    BROOKLYN, N.Y. — Insurers’ claims that chiropractors and practices submitted allegedly fraudulent charges and violated the Racketeer Influenced and Corrupt Organizations (RICO) Act raise fact issues for a jury, a federal judge in New York ruled in a June 24 unpublished memorandum, denying a motion for partial summary judgment and a cross-motion for summary judgment in all but one respect.

  • July 15, 2021

    Federal Judge Refuses To Toss Insurers’ $3.1M Fraud Suit Against Health Care Clinics

    TAMPA, Fla. — A federal judge in Florida on June 14 refused to dismiss insurers’ lawsuit seeking to recover $3.1 million from health care clinics and their personnel for alleging  submitting thousands of fraudulent no-fault insurance charges, finding that the insurers satisfied the pleading requirements under Federal Rules of Civil Procedure and sufficiently pleaded allegations to assert claims for relief.

  • July 15, 2021

    Parties Agree To Dismiss Claims In Fraud, RICO Suit Over Alleged Billing Scheme

    MIAMI — Parties in a fraud and Racketeer Influenced and Corrupt Organizations (RICO) Act lawsuit filed by Government Employees Insurance Co. (GEICO) and its affiliates against a chiropractor and a number of clinics he owned over allegedly fraudulent billing the defendants made for all services they provided have jointly agreed to dismiss their respective claims and counterclaims with prejudice, according to a joint stipulation of dismissal GEICO filed June 3 in Florida federal court.

  • July 14, 2021

    Federal Judge Blocks Portion Of New Florida Property Insurance Law

    TALLAHASSEE, Fla. — A portion of a new Florida property insurance law that bans “written or electronic communication that encourages, induces or instructs someone to contact a contractor or public adjuster for the purpose of filing an insurance claim for roof damage” violates First Amendment rights, a federal judge in Florida ruled July 11 in granting a preliminary injunction that prohibits the secretary of the Florida Department of Business and Professional Regulation from enforcing the law as it pertains to “prohibited advertisements.”

  • July 13, 2021

    High Court Review Of Uberrimae Fidei Use In Marine Insurance Suit Sought

    WASHINGTON, D.C. — U.S. Supreme Court review of the First Circuit U.S. Court of Appeals’ strict application of the uberrimae fidei doctrine in a marine insurance dispute stemming from alleged material omissions made by an insured in his application for insurance is necessary to cure a 4-2-1 split among federal circuit courts as to the proper application of the doctrine in such insurance disputes, the insured argues in a June 17 petition for writ of certiorari.

  • July 13, 2021

    California Appeals Court Affirms Denial Of Anti-SLAPP Motion

    SANTA ANA, Calif. — A trial court did not err in denying an anti-Strategic Lawsuit Against Public Participation (SLAPP) motion by a defendant accused of producing fraudulent medical reports and engaging in fraudulent billing practices, a California appellate panel concluded in a June 28 unpublished ruling.

  • July 12, 2021

    St. Jude Pays $27M For False Claims Stemming From Defective Heart Devices

    WASHINGTON, D.C. — St. Jude Medical LLC has agreed to pay $27 million to resolve allegations that it caused false claims to be submitted to three federal health care programs by failing to disclose a deadly battery defect in implantable heart devices St. Jude used to make, according to a settlement agreement disclosed July 8 by the U.S. Justice Department.

  • July 08, 2021

    Medical Device Maker To Pay Nearly $39M To Settle False Claims Act Allegations

    WASHINGTON, D.C. — Medical device manufacturers Alere Inc. and Alere San Diego Inc. (collectively, Alere) will pay $38.75 million to settle claims with the U.S. Department of Justice alleging that Alere violated the False Claims Act (FCA) by billing, and causing customers to bill, Medicare for rapid point-of-care devices, known as INRatio blood coagulation monitors, that the companies knew were defective, the department announced in a press release on July 8.

  • July 08, 2021

    Insurer’s Misrepresentation Affirmative Defense Claim Revived On Appeal

    DAYTONA BEACH, Fla. — Although Florida law sets a timeframe for insurers to investigate claims and make payments, the statutes do not bar insurers from contesting the insurance claim, a Florida appellate panel ruled July 2 in reversing a state trial court’s grant of summary judgment in favor of a claimant.

  • July 07, 2021

    Dismissal, Sanctions Award Against Insurer In Fraud Suit Affirmed On Appeal

    ST. PAUL, Minn. — A Minnesota Court of Appeals panel on June 21 affirmed a trial court’s grant of summary judgment and sanctions award in favor of a medical clinic, its owner and two of the clinic’s managers in an insurance fraud dispute, ruling that none of the insurer’s arguments on appeal supports a ruling to the contrary.

  • July 07, 2021

    GEICO Permitted To Amend Complaint In Insurance Fraud Suit Against Chiropractors

    BROOKLYN, N.Y. — A federal magistrate judge in New York on July 5 granted an insurer and its affiliates leave to amend their complaint against several New York- and New Jersey-based chiropractors in an insurance fraud lawsuit, ruling that although a chiropractor and his practice have opposed the motion, those defendants have failed to plead any allegations supporting a finding of bad faith, undue delay or undue prejudice in allowing an amendment.

  • June 30, 2021

    Default Judgment Awarded To Insurer In Fraud Suit Against Insured’s Employee

    FRESNO, Calif. — A federal judge in California on June 28 adopted a federal magistrate judge’s recommendation that an entry of default be entered against an insured’s employee in an insurer’s lawsuit alleging that the employee misappropriated $263,888 from its insured, ruling that the magistrate judge’s findings and recommendation were supported by the record and that the magistrate judge conducted a sufficient analysis of the facts.

  • June 16, 2021

    Physician Seeks Supreme Court Review Of Health Care Fraud Conviction

    WASHINGTON, D.C. — A physician on June 3 asked the U.S. Supreme Court to review a Fifth Circuit U.S. Court of Appeals ruling affirming his conviction on charges related to his alleged role in a health care fraud scheme, arguing that review is necessary because the appellate court’s ruling has compromised the due process rights of the physician and other federal health care program providers.

  • June 16, 2021

    High Court Asked To Weigh In On Health Care Fraud Conviction

    WASHINGTON, D.C. — U.S. Supreme Court review of a Fifth Circuit U.S. Court of Appeals ruling affirming the conviction of a doctor for his alleged involvement in a health care fraud scheme is necessary to address whether Medicare “rules, regulations and policies” are “controlling” in a criminal prosecution, a doctor argues in a petition for writ of certiorari filed June 3 in the Supreme Court.

  • June 15, 2021

    Insured Sanctioned In Insurance Fraud Suit Over Failure To Comply With Orders

    EAST ST. LOUIS, Ill. — A federal magistrate judge in Illinois on June 11 ruled that although more severe sanctions are not warranted against an insured that has failed to comply with court orders compelling discovery in an insurance fraud dispute, requiring the insured to pay for all reasonable costs and expenses associated with taking his deposition in the action is appropriate.

  • June 14, 2021

    Insurer Seeks Declaration That No Duty To Defend Owed In Personal Injury Suit

    BROOKLYN, N.Y. — An insurer filed a lawsuit in New York federal court on June 9, seeking declaration that it owes no duty to defend or indemnify its insured and another party in an underlying personal injury lawsuit stemming from a construction site accident, claiming that a policy exclusion applies and that the insured fraudulently sought additional insured coverage to receive policy benefits.

  • June 14, 2021

    S.C. Federal Judge Allows Expert On Methods For Reporting Suspected Fraud

    BEAUFORT, S.C. — An expert testifying in a False Claims Act suit on ways a health care provider can report suspected fraud to the government and opining on reasons why a provider might file an anonymous report was admitted by a South Carolina federal judge on June 3, but the judge barred his conclusions on the provider’s “motivation,”