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Mealey's Insurance Fraud

  • January 23, 2020

    Psychiatrist Sentenced To 27 Months In Prison For Fraudulent Billing Scheme

    NORFOLK, Va. — A psychiatrist was sentenced to 27 months in prison and ordered to pay $465,942 in restitution by a federal judge in Virginia on Jan. 16 after the defendant pleaded guilty in September to one count of health care fraud for submitting false bills to Medicare, Medicaid and other insurers (United States v. Udaya Shetty, No. 19-cr-89, E.D. Va.).

  • January 23, 2020

    DOJ: Doctor Agrees To Pay $1.1M For Services Provided To Elderly Patients

    NEW YORK — An otolaryngologist on Dec. 19 entered into an agreement with the federal government to pay $1.1 million to resolve allegations that he violated the False Claims Act when paying kickbacks and submitting fraudulent claims for medically unnecessary allergy tests and other services, the U.S. Department of Justice (DOJ) announced Jan. 20.

  • January 22, 2020

    Doctor Sentenced For Making False Statements Over Treatment Of Elderly Patients

    CEDAR RAPIDS, Iowa — A federal judge in Iowa on Jan. 17 sentenced a doctor to two months in prison and ordered him to pay $117,199.32 in restitution after he pleaded guilty to making false statements to federal investigators over his upcoding of claims he submitted to Medicare and Medicaid for the treatment of patients in nursing homes (United States v. Joseph X. Latella, No. 19cr3030, N.D. Iowa).

  • January 21, 2020

    Pharmacy, Owners, To Appeal Ruling Barring Future Collection Suits Against GEICO

    NEW YORK — A pharmacy and its two owners filed a notice of appeal in New York federal court on Jan. 17, stating that they will ask the Second Circuit U.S. Court of Appeals to review a federal judge’s Jan. 16 ruling that stayed pending collection arbitration actions and barred the filing of any future state court collection actions against an insurer that is accusing them of submitting claims under New York’s no-fault law for medically unnecessary pain medications (Government Employees Insurance Co., et al. v. Wellmart RX Inc., et al., No. 19-CV-04414, E.D. N.Y.).

  • January 21, 2020

    2nd Circuit Upholds Man’s Conviction, Sentence For Role In STOLI Policy Scheme

    NEW YORK — A Second Circuit U.S. Court of Appeals panel on Jan. 13 affirmed a man’s conviction and 30-month prison sentence for a scheme involving stranger-obtained life insurance (STOLI) policies, finding that a federal judge in Connecticut did not err by refusing to suppress evidence from search warrants and that decisions extending time to the defendant did not violate the Speedy Trial Act (United States v. Wayne Bursey, et al., No. 19-70-cr, 2nd Cir., 2020 U.S. App. LEXIS 1350).

  • January 14, 2020

    11th Circuit Upholds Order Requiring Neurologist To Pay $15M Restitution

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Jan. 13 upheld a ruling requiring a neurologist who pleaded guilty to one count of health care fraud and one count of unlawful distribution of controlled substances to pay $15 million in restitution in addition to his five-year prison sentence, holding that the presentence investigation report (PSI) contained sufficient information about the amount of loss that occurred as a result of the defendant’s scheme (United States v. Rassan M. Tarabein, No. 18-13743, 11th Cir., 2020 U.S. App. LEXIS 1023).

  • January 13, 2020

    Investors’ Convictions, Sentences For Roles In Staged Accident Scheme Upheld

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Jan. 9 upheld the convictions and sentences of two investors who operated three clinics that submitted fraudulent bills to private insurers for services provided to patients purportedly injured in staged automobile accidents, finding that the evidence presented by the government was sufficient to support the jury’s verdict (United States v. David Sosa-Baladron, et al., Nos. 17-1987, 17-2032, 6th Cir., 2020 U.S. App. LEXIS 876).

  • January 10, 2020

    Convicted Cardiologist’s Challenges To Testimony Overruled By 6th Circuit

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Jan. 7 upheld the conviction of a cardiologist accused of health care fraud for implanting unnecessary pacemakers in more than 50 patients, holding that a federal judge in Kentucky did not err when allowing testimony from a doctor who testified that the device was not necessary for more 20 unnamed patients (United States v. Anis Chalhoub, M.D., No. 18-6180, 6th Cir., 2020 U.S. App. LEXIS 572).

  • January 09, 2020

    Doctors’ Suit Over Constitutionality Of State’s Insurance Fraud Law Dismissed

    NEWARK, N.J. — A lawsuit brought by two doctors challenging the constitutionality of the New Jersey Insurance Fraud Prevention Act (IFPA) was dismissed Jan. 7 by a federal judge in New Jersey after he found that the plaintiffs lacked standing under Article III of the U.S. Constitution (Harshad Patel M.D., et al. v. Richard Crist, et al., No. 19-8946, D. N.J., 2020 U.S. Dist. LEXIS 2111).

  • January 08, 2020

    Podiatrist’s Conviction, Sentence For Fraudulently Billing Nail Avulsions Upheld

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Jan. 6 upheld a podiatrist’s 24-month prison sentence and order requiring him to pay $83,252.63 in restitution, finding that the evidence presented during a trial support the conviction and that a federal judge in Tennessee did not err when calculating the amount of loss (United States v. John J. Cauthon, No. 18-5613, 6th Cir., 2020 U.S. App. LEXIS 393).

  • January 07, 2020

    GEICO Need Not Pay Claims For Upcoded Services, Judge Rules

    MIAMI — A federal judge in Florida on Dec. 20 granted in part a motion for summary judgment filed by the Government Employees Insurance Co. (GEICO) and its affiliates in a suit accusing a clinic of submitting false bills for physical therapy services, finding that the insurer is entitled to a declaration stating that it is not required to pay outstanding bills for services that were fraudulently upcoded and provided by unqualified individuals (Government Employees Insurance Co., et al. v. Quality Diagnostic Health Care Inc., et al., No. 18-20101-CIV-MARTINEZ/OTAZO-REYES, S.D. Fla., 2019 U.S. Dist. LEXIS 220674).

  • January 07, 2020

    California Panel: Lawyer’s Demand Letters To Insurer Can Support Fraud Claims

    LOS ANGELES — A California appeals court panel on Dec. 23 affirmed a ruling denying a lawyer and law firm’s motion to strike allegations brought against them by Allstate Insurance Co. over an alleged insurance fraud scheme, finding that demand letters sent by the defendants to the insurer are not protected activity under California law (People of the state of California, ex rel. Allstate Insurance Co. v. Kelly L. Casado, et al., No. B288742, Calif. App., 2nd Dist., 7th Div., 2019 Cal. App. Unpub. LEXIS 8572).

  • January 06, 2020

    Magistrate Judge Recommends Granting Motion To Enforce Subpoena On Nonparty

    MIAMI — A federal magistrate judge in Florida on Dec. 20 recommended granting a petition to enforce a subpoena that seeks the deposition of a Miami-based business owner, finding that his testimony could be relevant to a lawsuit brought by State Farm Mutual Automobile Insurance Co.  in federal court in New York against 20 defendants accused of submitting false claims for no-fault benefits because the defendants sent him large sums of money during the alleged scheme (State Farm Mutual Automobile Insurance Co. v. Vladimir Maistrenko, No. 19-MC-20850-SCOLA-TORRES, S.D. Fla., 2019 U.S. Dist. LEXIS 221150).

  • January 02, 2020

    Judge:  State Farm Sufficiently States RICO Claim Against Doctor Over Billing

    HOUSTON — A federal judge in Texas on Dec. 31 denied motions to dismiss filed by a doctor as well as the owners of a clinic where the doctor performed procedures on patients who were allegedly injured in automobile accidents, finding that State Farm Mutual Automobile Insurance Co. and an affiliate sufficiently stated a claim against the doctor under the Racketeer Influenced and Corrupt Organizations Act and claims for money had and received (State Farm Mutual Automobile Insurance Co. v. Nooruddin S. Punjwani, et al., No. H-19-1491, S.D. Texas, 2019 U.S. Dist. LEXIS 223054).

  • December 19, 2019

    Judge: Insurer Has Enough Evidence For Fraud Claim Against Insured, Caregiver

    OKLAHOMA CITY — An insurance company that reimbursed a former orthopedic surgeon for services that assisted him with activities of daily living (ADLs) has sufficient evidence to pursue claims for fraud and deceit against the insured and his caregiver, a federal judge in Oklahoma ruled Dec. 17 in denying the defendants’ motion for partial summary judgment, holding that the record shows that the defendants created a payment mechanism that misrepresented how the payment of the insured’s claims were being distributed (Allianz Life Insurance Co. of North America v. Gene L. Muse, et al., No. CIV-17-1361-G, W.D. Okla., 2019 U.S. Dist. LEXIS 217444).

  • December 18, 2019

    Doctor’s Conviction For Health Care Fraud Involving 5 Elderly Patients Upheld

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Dec. 16 affirmed a doctor’s conviction for one count of conspiracy to commit health care fraud and five counts of health care fraud for submitting false bills for treatment of five elderly patients with dementia, as well as a federal judge’s decision to sentence him to 150 months in prison, holding that the evidence presented during trial was sufficient (United States v. Riyaz Mazkouri, No. 18-20650, 5th Cir., 2019 U.S. App. LEXIS 37167).

  • December 17, 2019

    United States: Pharmacy Fraudulently Refilled Long-Term Care Prescriptions

    NEW YORK — The U.S. Justice Department on Dec. 17 intervened in a whistleblower lawsuit alleging that long-term care pharmacy Omnicare Inc. fraudulently refilled prescriptions without physician authorization, sometimes for years (United States, et al, ex rel. Uri Bassan v. Omnicare, Inc., No. 15-4179, S.D. N.Y.).

  • December 13, 2019

    2 Indictments Charge 10 Former NFL Players With Health Care Fraud

    LEXINGTON, Ky. — Two indictments filed under seal on Dec. 6 in Kentucky federal court and unsealed Dec. 12 charge 10 former National Football League players with participating in a nationwide health care fraud scheme that resulted in the submission of $3.9 million in fraudulent claims to the Gene Upshaw NFL Player Health Reimbursement Account Plan between June 2017 and December 2018 and $3.4 million in payouts (United States v. Correll Buckhalter, et al., No. 19-cr-205, United States v. Robert McCune, et al., No. 19-cr-206, E.D. Ky.).

  • December 10, 2019

    Judge Finds Arbitration Does Not Trigger Jurisdiction Over Insurer’s Fraud Claims

    NEW YORK — A federal judge in New York on Dec. 5 denied an insurer’s motion to reconsider a ruling finding that an ambulatory services provider’s arbitration proceedings against the company trigger personal jurisdiction over the insurer’s fraud and unjust enrichment claims, holding that New York’s no-fault law allows the insured to attempt to collect unpaid claims through arbitration (Allstate Insurance Co., et al. v. Sangwoo Mah, et al., No. 19-cv-2866, E.D. N.Y., 2019 U.S. Dist. LEXIS 209836).

  • December 04, 2019

    Judge Rules Fraud Defendant’s Counsel Was Effective, Refuses To Vacate Sentence

    KALAMAZOO, Mich. — A federal judge in Michigan on Dec. 3 refused a to vacate a man’s 87-month prison sentence after he was convicted by a federal jury on charges of health care fraud and mail fraud, finding that he received effective assistance of counsel (United States v. Antonio Martinez-Lopez, No. 16-CR-62, W.D. Mich., 2019 U.S. Dist. LEXIS 207544).