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Mealey's Insurance Fraud

  • May 26, 2017

    Judge: Contractor’s Misrepresentations Warrant Voiding Policy

    CENTRAL ISLIP, N.Y. — A federal judge in New York on May 24 entered summary judgment in favor of Scottsdale Insurance Co., finding that misrepresentations made by a carpentry contractor on its policy application were material (Scottsdale Insurance Company v. Pine Construction Corp., No. 15-cv-4764, E.D. N.Y., 2017 U.S. Dist. LEXIS 80475).

  • May 26, 2017

    Woman Loses Bid For Habeas Relief Based On Fire Expert’s Arson Finding

    DETROIT — A Michigan federal judge on May 25 upheld the conviction of a woman for setting fire to her house to collect insurance money after rejecting her challenge to an expert’s opinion that the fire was caused by arson (Audrey Pruitt v. Anthony Stewart, No. 2:15-cv-10812, E.D. Mich., 2017 U.S. Dist. LEXIS 80162).

  • May 25, 2017

    Psychiatrist Found Guilty Of 5 Counts Of Health Care Fraud For $158M Scheme

    HOUSTON — A psychiatrist in Texas was found guilty by a federal jury on May 23 of five counts of health care fraud and one count of conspiracy to commit health care fraud for his role in a $158 million fraud scheme that involved submitting fraudulent claims for partial hospitalization program (PHP) services (United States of America v. Riyaz Mazkouri, No. 16cr213, S.D. Texas).

  • May 23, 2017

    DOJ: Michigan Doctor Sentenced To 19 Years For Fraud, Distributing Drugs

    DETROIT — A federal judge in Michigan on May 18 sentenced a doctor to 19 years in prison after the doctor was found guilty of conspiracy to distribute prescription drugs and conspiracy to commit health care fraud, the U.S. Department of Justice announced (United States of America v. Damon Mason, et al., No. 11cr20551, E.D. Mich.).

  • May 22, 2017

    4 Sentenced For Roles In Fraudulently Billing Medicare For Services Not Provided

    CLEVELAND — Four individuals were sentenced by a federal judge in Ohio on May 19 for their roles in an $8 million Medicare fraud scheme that involved forging documents and billing the insurer for medical services that were not provided (United States of America v. Delores L. Knight, et al., No. 15-cr-222, N.D. Ohio).

  • May 18, 2017

    Judge Refuses To Dismiss Fraud Claims Against Man Accused Of Concealing Coverage

    OXFORD, Miss. — A federal judge in Mississippi on May 16 denied a man’s motion for partial summary judgment on fraud claims brought by passengers who were injured in an accident while he was driving, ruling that a jury will decide whether he knew he had additional insurance coverage under his parents’ umbrella policy (Allstate Insurance Company v. John Robert Scarborough, No. 15-cv-00114-MPM-RP, N.D. Miss., 2017 U.S. Dist. LEXIS 74301).

  • May 18, 2017

    Former Judge Pleads Guilty For Role in $550M Social Security Disability Scheme

    LEXINGTON, Ky. — A former administrative law judge pleaded guilty in Kentucky federal court on May 12 to two counts of receiving illegal gratuities in connection with a $550 million scheme that involved acquiring disability benefits for Social Security recipients (United States of America v. David B. Daughtery, No. 17cr66, E.D. Ky.).

  • May 18, 2017

    Mass. Appeals Court Upholds Insurance Fraud Verdict, Reverses Larceny Conviction

    BOSTON — An appeals panel in Massachusetts on May 9 found that a trial court judge did not err when admitting an insurance coverage sheet and accident report during the trial of man charged with motor vehicle insurance fraud, but ruled that the judge did not properly instruct the jury about the charge of larceny (Commonwealth v. Bryan Driscoll, No. 2015-P-1689, Mass. App., 2017 Mass. App. LEXIS 55).

  • May 17, 2017

    State Sufficiently Proved Venue In Insurance Fraud Suit, Appeals Court Finds

    LIMA, Ohio — An Ohio Court of Appeals panel on May 15 ruled that man was properly convicted of one count of insurance fraud, finding that the prosecution provided sufficient evidence regarding the location of the incident (State of Ohio v. Timothy Jon McVety, No. 8-16-19, Ohio App., 3rd Dist., Logan Co., 2017 Ohio App. LEXIS 1848).

  • May 16, 2017

    Judge Affirms Ruling Finding Conflict Between Fraud Defendant And Attorney

    BUFFALO, N.Y. — A federal judge in New York on May 12 upheld a magistrate judge’s decision finding that an attorney representing a man accused of health care fraud should be removed as his counsel due to a conflict of interest because the government intends to call him as a witness (United States of America v. Eugene Gosy, No. 16-cr-46-FPG, W.D. N.Y., 2017 U.S. Dist. LEXIS 72989).

  • May 11, 2017

    Texas Couple Sentenced For Fraudulently Inflating Mileage Billed To Medicare

    TYLER, Texas — A federal judge in Texas on May 8 sentenced a couple who pleaded guilty to conspiracy to commit health care fraud for inflating mileage they incurred when providing laboratory services to nursing homes and ordered them to pay $161,695 (United States of America v. Gerard Dengler, et al., No. 16-cr-48, E.D. Texas).

  • May 11, 2017

    Doctor Not Guilty On 2 Counts Of Conspiracy To Commit Health Care Fraud

    DETROIT — A federal jury in Michigan on May 8 found that a doctor accused of participating in a $17.1 million Medicare fraud scheme was not guilty of two counts of conspiracy to commit health care fraud, but guilty of one count of health care fraud (United States of America v. Gerald Daneshvar, No. 15-cr-20362, E.D. Mich.).

  • May 8, 2017

    New Jersey High Court Finds Attorney, Chiropractor Violated Fraud Prevention Act

    TRENTON, N.J. — The New Jersey Supreme Court on May 4 unanimously affirmed a trial court’s finding that a chiropractor and attorney who promoted a scheme that encouraged the creation of medical practices that were operated by doctors with a limited scope of practice violated the New Jersey Insurance Fraud Prevention Act (IFPA), overruling an appellate court’s decision that there was not enough evidence to support such a finding (Allstate Insurance Company, et al. v. Northfield Medical Center, P.C., et al., No. A-27 September Term 2015, 076069, N.J. Sup., 2017 N.J. LEXIS 431).

  • May 4, 2017

    GEICO’s Amended Complaint Puts Clinic On Notice Of Allegedly Fraudulent Scheme

    MIAMI — An amended complaint filed by the Government Employees Insurance Co. (GEICO) properly put a health care clinic and its owners of notice of claims that the defendants violated Florida law and submitted fraudulent claims for coverage, a federal judge in Florida ruled May 2 in denying the defendants’ motion for a more definite statement (Government Employees Insurance Company, et al. v. Benefica Health Center, Corp., et al., No. 17-20161-CIV-MORENO, S.D. Fla., 2017 U.S. Dist. LEXIS 66542).

  • May 2, 2017

    DOJ: Woman Sentenced To 21 Months, Ordered To Pay $1.6M For Billing Scheme

    NEW HAVEN, Conn. — The U.S. Department of Justice announced April 27 that a woman was sentenced by a federal judge in Connecticut to 21 months in prison and ordered to pay $1.6 million in restitution for her role in a scheme that involved fraudulently billing Medicare for psychotherapy services that were never rendered (United States of America v. Patricia Lafayette, No. 16-cr-140, D. Conn.).

  • April 27, 2017

    5th Circuit Upholds Ruling Finding Couple’s Policy Void For Misrepresentation

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on April 26 affirmed a federal judge in Mississippi’s ruling that a homeowners policy issued by State Farm Fire & Casualty Co. was void, ruling that the judge did not err when finding that the couple’s misrepresentation over ownership of the property was material (State Farm Fire & Casualty Company v. Cedric Flowers, et al, No. 16-60310, 5th Cir., 2017 U.S. App. LEXIS 7400).

  • April 24, 2017

    Appeals Court Affirms Judge’s Decision To Convict Woman For Insurance Fraud

    DALLAS — A Texas appeals panel on April 20 upheld a trial court judge’s decision to revoke a woman’s sentence for four years of community supervision and sentence her to 10 years in prison for insurance fraud, ruling that there was sufficient evidence showing that she committed a new offense of theft from an elderly person (Christine Zimmerman Shearer v. State of Texas, No. 05-16-00317-CR, Texas App., 5th Dist., 2017 Tex. App. LEXIS 3584).

  • 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).