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Mealey's Insurance Fraud

  • June 21, 2022

    Relator Appeals Dismissal Of False Claims Complaint Against No-Fault Insurers

    ATLANTA — The widow of an injured man on May 31 filed a corrected brief with the 11th Circuit U.S. Court of Appeals, seeking reversal of a judgment that dismissed the couple’s False Claims Act (FCA) suit against insurers alleging that they caused the man’s health care providers to present false claims to the Centers for Medicare and Medicaid Services (CMS) and that by hiding purported responsibility as primary payers, the insurers forced the couple to reimburse CMS for post-settlement medical care.

  • June 20, 2022

    ‘Evidence Easily’ Supports Defendants’ Fraud Convictions, U.S. Tells 11th Circuit

    ATLANTA — The United States on June 13 argued to the 11th Circuit U.S. Court of Appeals that the evidence easily supports defendants’ health care and mail fraud convictions stemming from their involvement in a scheme to submit bills to insurance companies for medically unnecessary prescriptions for a compounding pharmacy’s drugs, further arguing that the lower federal court did not clearly err in calculating restitution and forfeiture amounts.

  • June 17, 2022

    Judge Enjoins Medical Device Company From Filing Collection Actions Against GEICO

    BROOKLYN, N.Y. — A New York federal judge on June 2 granted GEICO’s motion to enjoin a medical device supplier from filing new collections actions against it in a declaratory judgment suit seeking a judgment that it is not obligated to pay the supplier’s claims for durable medical equipment that was allegedly not provided, finding that GEICO would “suffer irreparable harm” without enjoining “new actions and arbitration proceedings.”

  • June 17, 2022

    Judge Strikes Report Of Expert Witness On Billing In Insurance Fraud Dispute

    TAMPA, Fla. — A Florida federal judge on June 14 agreed to strike a report and exclude testimony at trial in an insurer’s suit seeking to recover $2.1 million for allegedly fraudulent no-fault insurance charges, finding a violation of Federal Rule of Civil Procedure 26 because an expert witness retained by a health care clinic and its personnel “did not substantially participate in preparing the Report.”

  • June 17, 2022

    Hospital Refutes Amicus’ Assertion That Court Order ‘Guts’ California’s IFPA

    LOS ANGELES — A hospital on May 5 filed an answer to The Anti-Fraud Alliance’s amicus curiae brief in support of the state of California in a qui tam lawsuit alleging that the hospital participated in kickbacks, patient steering and billing fraud schemes, contending that nothing in the amicus brief provides any basis to warrant reversal of a lower court’s judgment in its favor in the action brought under the California Insurance Frauds Prevention Act.

  • June 08, 2022

    Michigan Panel Finds Questions Of Fact Over Insurance Fraud

    DETROIT — A Michigan appellate court on June 2 vacated and remanded a trial court’s opinion granting summary disposition in favor of insurance companies, finding that there were questions of fact regarding fraud, rescission and ownership in a case where the owner of a medical transportation company suffered injuries in a car accident while operating a company-owned vehicle in his capacity as an employee of the company.

  • June 08, 2022

    N.J. High Court To Review Application Of Comparative Negligence Act In Fraud Case

    TRENTON, N.J. — The New Jersey Supreme Court on June 6 granted certification of an appellate court ruling vacating a multimillion-dollar judgment against insureds in a workers’ compensation fraud case and remanding for a new trial, agreeing to review whether the  Comparative Negligence Act applies and whether the jury instructions should have included an ultimate outcome charge.

  • June 08, 2022

    Questions Of Fact Exist Regarding Insured’s Alleged Misrepresentations, Judge Says

    SEATTLE — A Washington federal judge on May 20 determined that questions of fact exist as to whether an insured who is seeking coverage for fire damages to his home intentionally started the fire and whether the insured misrepresented the condition of his home and the contents inside of the home before the damages incurred by the fire.

  • June 08, 2022

    Judge Refuses To Vacate Judgment Against Insured In Workers’ Comp, Fraud Suit

    NEW YORK — A New York federal judge on May 31 denied an insured’s motion to vacate a default judgment and a $1.6 million judgment entered in favor of a workers’ compensation insurer in a breach of contract and fraud suit after determining that the insured was properly served and failed to offer any meritorious defenses for not responding to the complaint.

  • June 08, 2022

    Homeowners Insurer Is Entitled To Restitution; Policy Properly Rescinded

    DETROIT — A homeowners insurer is entitled to reimbursement for a payment made to an insured following a fire at the insured’s home because the insurer properly rescinded the policy based on a misrepresentation made by the insured and is entitled to restitution as an equitable remedy for the rescission of the policy, a Michigan federal judge said May 19.

  • June 08, 2022

    Panel Affirms $4.5M Judgment Against Insurer That Failed To Prove Fraud

    KANSAS CITY, Mo. — A Missouri appellate panel on May 31 affirmed a trial court’s judgment against an insurer for $4.5 million awarded to a driver involved in a collision with an insured’s vehicle, finding that the insurer did not meet its burden of proving a fraudulent insurance act even though a noninsured driver operated the vehicle and waived its right to rescind the policy before the collision.

  • June 08, 2022

    Relator Award Of $533,007 Appealed In $32M Health Care False Claims Verdict

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on May 16 ordered briefing to begin June 27 in an appeal by five health care defendants of a March 30 award of $533,007 in relator fees, expenses and costs in a false claims case that resulted in $32 million in treble damages.

  • June 08, 2022

    Panel:  Property Owner Not Entitled To Coverage For Fire Damage To Bar

    DETROIT — A Michigan Court of Appeals on May 12 found that an insurer is not liable to a property owner additional insured for fire damage to a bar on its property, reversing a lower court, but affirmed the lower court’s ruling that the insurer is entitled to summary judgment on the property owner’s claim for reformation of the policy to include coverage for property damage.

  • June 08, 2022

    Health Provider Again Urges High Court Review Of FCA Dispute, Disputes Government

    WASHINGTON, D.C. — In the wake of the United States’ May 24 amicus brief urging the U.S. Supreme Court not to review the pleading standard in a similar False Claims Act (FCA) case, a health care services provider on May 31 filed a supplemental brief in its own appeal, disagreeing with the government and urging the court to grant review or at least hold the case pending the disposition of the other case.

  • June 07, 2022

    Insurer Seeks Reconsideration Of Michigan Panel’s Ruling In Suit Over PIP Claims

    LANSING, Mich. — An insurer on June 2 moved for reconsideration of a Michigan appeals court’s May 12 ruling that the insurer cannot rescind an automobile insurance policy and cannot “flatly reject” any of its insured’s claims for attendant care or replacement services in a coverage dispute over personal injury protection (PIP) benefits.

  • June 07, 2022

    Life Insurer Granted Judgment; Policy Voided For Material Misrepresentations

    MIAMI — A federal judge in Florida on April 28 granted summary judgment to an insurer seeking a declaration that a life insurance policy it issued is void, agreeing with the insurer that the insured, who died less than two years after the policy was issued, made material misrepresentations in his insurance application regarding his medical history and use of alcohol and other substances.

  • June 07, 2022

    State Court Stay Denial Warrants Reconsideration, State Farm Says

    BROOKLYN, N.Y. — A decision not to stay hundreds of state court lawsuits empowers medical providers accused of unlawfully obtaining insurance for unnecessary health care services to profit off the process and is wrong on the law, plaintiffs tell a federal judge in New York in seeking reconsideration on June 2.

  • June 03, 2022

    Beneficiary Appeals Summary Judgment Ruling For Life Insurer To 7th Circuit

    CHICAGO — A life insurance beneficiary on April 12 appealed an Illinois federal court’s March 30 finding that her husband’s cancer diagnosis was material to the risk undertaken by the insurer and that he misrepresented his health when he received the policy or the policy never went into effect because he did not sign the delivery receipt.

  • June 02, 2022

    Parties To Windshield Claim Fraud Case Denied Attorney Fees, For Now

    TAMPA, Fla. — A federal judge in Florida on May 18 adopted a recommendation denying several motions for attorney fees, saying a pending appeal in a case alleging that a company submitted fraudulent windshield repair claims renders such awards unwarranted and could only complicate the judicial process.

  • June 01, 2022

    Judge Won’t Dismiss Insurance Fraud Claims Against Chiropractors’ Clinics, Staff

    TAMPA, Fla. — A group of chiropractors, other medical professionals and staff and five affiliated clinics on May 24 filed answers in a Florida federal court denying an insurer’s claims that they participated in a five-year $2.1 million scheme to collect fraudulent no-fault automobile insurance benefits after the court on May 3 rejected all of their arguments for dismissal of the claims.