Mealey's Insurance Fraud

  • 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).

  • February 13, 2017

    Mental Health Facility Administrator Found Guilty For Kickback Scheme

    SHREVEPORT, La. — A federal jury in Louisiana on Feb. 10 found a mental health care facility administrator guilty of organizing a kickback scheme that resulted in the submission of $6.7 million in fraudulent bills to Medicare, the U.S. Attorney’s Office announced (United States of America v. Tom McCardell, No. 16-cr-212, W.D. La.).

  • February 13, 2017

    Judge: Insurer Sufficiently States Claims Against Alleged Sham Law Firm

    SEATTLE — A federal judge in Washington on Jan. 23 denied a motion to dismiss filed by defendants accused of trafficking personal injury claims and submitting them to an insurance company, ruling that the insurer sufficiently stated claims for relief in its amended complaint (Allstate Insurance Co., et al. v. Lighthouse Law P.S., Inc., et al., No. C15-1975RSL, W.D. Wash.).

  • February 10, 2017

    Judge Quashes Insurer’s Subpoena On Google Seeking Firm’s Emails

    SEATTLE — A federal judge in Washington on Feb. 7 quashed a subpoena served on Google Inc. by Allstate Insurance Co., finding that the insurer’s request for documents related to records from email accounts associated with a law firm accused of submitting fraudulent insurance claims are shielded from discovery by the Stored Communications Act (SCA) (Allstate Insurance Co. v. Lighthouse Law P.S. Inc., et al., No. C15-1976RSL, W.D. Wash., 2017 U.S. Dist. LEXIS 17284).

  • February 8, 2017

    U.S. Attorney’s Office: Podiatrist Sentenced To 97 Months For Fraud Scheme

    PHILADELPHIA — A judge in Pennsylvania federal court sentenced a former podiatrist to 97 months in prison and ordered him to pay $4.9 million in restitution after pleading guilty to health care fraud for submitting bills to Medicare, Medicaid and private insurers for procedures that were not performed or medically unnecessary, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced Feb. 7 (United States of America v. Stephen A. Monaco, No. 16cr255, E.D. Pa.).

  • February 8, 2017

    Judge Enters Default Judgment Against Lawyer In Professional Liability Dispute

    NEWARK, N.J. — A New Jersey federal judge on Feb. 3 granted a lawyers professional liability insurer’s motion for a default judgment against its attorney insured, finding that the insured knowingly made material misrepresentations on his insurance applications and that the insurer will also suffer prejudice if the default is denied (Liberty Insurance Underwriters, Inc. v. James H. Wolfe, III, et al., No. 16-2353, D. N.J., 2017 U.S. Dist. LEXIS 16295).

  • February 6, 2017

    U.S. Attorney: Florida Urologist To Pay $3.8M For Ordering Unnecessary Tests

    FORT MYERS, Fla. — The U.S. Attorney’s Office on Feb. 1 announced that a Florida urologist has agreed to pay $3.8 million for violating the False Claims Act (FCA) by submitting bills to Medicare for diagnostic tests that were unnecessary.

  • February 6, 2017

    Judge Refuses To Sever Claims Against Clinic Owners And Laboratory Owners

    FRANKFORT, Ky. — A federal judge in Kentucky on Jan. 30 refused to sever claims brought by the federal government against two physicians who were owners of an addiction clinic as well as partial owners of a laboratory that conducted urine drug tests that were fraudulently billed to public and private insurers, ruling that all of the defendants were associated with one another in their scheme (United States of America v. Brian C. Walters, et al., No. 15-cr-14-GVFT-REW, E.D. Ky., 2017 U.S. Dist. LEXIS 12294).

  • February 3, 2017

    Judge Tells Insurer To Explain Why Fraud Claims Are Not Forfeited

    DETROIT — A federal judge in Michigan on Jan. 31 ordered IDS Property Casualty Insurance Co. to explain why fraud claims it is asserting against a couple accused of intentionally setting fire to their home are not forfeited compulsory counterclaims that could have been raised when the couple initially sued the company over denied coverage (IDS Property Casualty Insurance Company v. Carlos Martell, et al., NO. 13-11758, E.D. Mich., 2017 U.S. Dist. LEXIS 12664).

  • February 2, 2017

    Judge Bars Celebrity From Selling $1.2M Home During Insurance Dispute

    MEMPHIS, Tenn. — A federal judge in Tennessee on Jan. 24 barred Christopher C. Brown from selling or encumbering his $1.2 million Tennessee home until a lawsuit accusing of him of fraud brought by his insurance company is resolved, finding that all four of the factors for injunctive relief were met (Hanover American Insurance Company v. Tattooed Millionaire Entertainment Inc., et al., No. 16-cv-28170-JPM-tmp, W.D. Tenn., 2017 U.S. Dist. LEXIS 9854).

  • January 26, 2017

    6th Circuit Affirms Dismissal Of Suit Accusing Walgreens Of Prescription Kickbacks

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Jan. 25 affirmed a federal judge in Tennessee’s ruling dismissing a pharmacy owner’s False Claims Act (FCA) lawsuit accusing a local Walgreen Co. pharmacy (Walgreens) of illegally paying kickbacks to Medicare and Medicaid beneficiaries by offering $25 gift cards to have their prescriptions filled at a nearby location, finding that the plaintiff did not sufficiently allege particularity (United States of America, ex. rel. Andrew Hirt v. Walgreen Company, No. 16-6232, 6th Cir.; 2017 U.S. App. LEXIS 1306).

  • January 24, 2017

    Misrepresentation On Lot Size Warrants Rescission Of Policy, Judge Rules

    ATHENS, Ga. — An insurer can rescind a homeowners policy it issued to a man who misrepresented on the policy application the size of the property he sought coverage for because the company provided evidence from its underwriter stating that it would not have issued the policy if it knew that the property was larger than five acres, a federal judge in Georgia ruled Jan. 23 in awarding summary judgment to the company (Great Lakes Reinsurance [UK] SE v. Charles Queen, No. 15-CV-123, M.D. Ga.; 2017 U.S. Dist. LEXIS 8491).

  • January 23, 2017

    Man’s Conviction, Sentence For Insurance Fraud Upheld By Ohio Appeals Court

    TOLEDO, Ohio — A trial court judge did not err when allowing a jury to hear evidence about an administrative hearing that concluded that a man should be terminated from his job for representing that he was married to obtain insurance benefits for his ex-wife because presentation of the information did not result in “a manifest miscarriage of justice,” an Ohio appeals court panel ruled Jan. 20 in affirming the man’s sentence and conviction (State of Ohio v. Marvin Arnold, No L-15-1126, Ohio App., 6th Dist.; 2017 Ohio App. LEIS 227).

  • January 19, 2017

    Former Doctor Pleads Guilty To Scheme Involving Examinations Of Veterans

    KANSAS CITY, Mo. — A Missouri doctor who surrendered his medical license in 2010 after pleading to an insurance fraud scheme pleaded guilty on Jan. 17 to another insurance fraud scheme in which he conducted disability examinations on veterans (United States of America v. Wayne Williamson, No. 17cr25, W.D. Mo.).

  • January 19, 2017

    Evidence Of Defendant’s Prior Insurance Fraud Inadmissible, Judge Rules

    WILMINGTON, Del. — The state of Delaware cannot introduce evidence regarding a man’s two prior instances of renter’s insurance fraud as part of its case to find the defendant guilty of a 2007 murder, a state court judge ruled Jan. 10, finding that the evidence’s probative value was outweighed by the danger of unfair prejudice (State of Delaware v. Jason Slaughter, No. 1207010738, Del Super., New Castle Co.; 2017 Del. Super. LEXIS 15).

  • January 19, 2017

    Owner Of Mobile Diagnostic Testing Facility Pleads Guilty To $1.5M Fraud Scheme

    TOPEKA, Kan. — The owner of a mobile diagnostic testing facility on Jan. 12 pleaded guilty to one count of health care fraud and admitted to billing Medicare and Medicaid for up to $1.5 million of services that were not ordered by a physician, not medically necessary and not performed (United States of America v. Cody Lee West, No. 16-cr-40116, D. Kan.).

  • January 19, 2017

    Lawyer’s Misrepresentations Were Material, Judge Says; Insurer Can Rescind Policy

    EAST ST. LOUIS, Ill. — A federal judge in Illinois on Jan. 10 granted in part an insurance company’s motion for summary judgment, finding that the company could rescind a policy it issued to a law firm because misrepresentations on the policy application were material (Carolina Casualty Insurance Company v. Robert S. Forbes, et al., No. 16-cv-40-JPG-SCW, S.D. Ill.; 2017 U.S. Dist. LEXIS 3422).

  • January 18, 2017

    Judge Affirms Earlier Ruling That Fraud Scheme Netted $2.9M In Losses

    NEW YORK — A federal judge in New York, who was ordered by the Second Circuit U.S. Court of Appeals to provide more detailed findings on the intended loss of an insurance fraud scheme that involved the redistribution of drugs originally provided to HIV and AIDS patients, on Jan. 17 affirmed his earlier decision that the scheme resulted in $2.9 million in losses to Medicare, finding that a ledger found at the man’s apartment detailed the prices and quantities of the drugs (United States of America v. Bladimir Rigo, No. 13 CR 897, S.D. N.Y.; 2017 U.S. Dist. LEXIS 6228).