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).
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).
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).
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.).
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).
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).
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.).
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).
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).
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).
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).
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.).
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).
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).
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.).
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).
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).
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).
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).
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).