Mealey's Insurance Fraud

  • September 20, 2017

    Woman Convicted For Taking Kickbacks In Medicare Fraud Scheme

    NEW ORLEANS — A woman was found guilty by a federal jury in Louisiana on Sept. 12 of paying and receiving kickbacks, identity theft and making false statements as part of a  $2.1 million Medicare fraud scheme (United States of America v. Kim Ricard, et al., No. 15cr232, E.D. La.).

  • September 20, 2017

    Judge Adjourns Fraud Trial So Defendant Can Review Recorded Sales Calls

    NASHVILLE, Tenn. — A federal judge in Tennessee on Sept. 19 granted a motion filed by a man accused of orchestrating a telemarketing scheme to sell insurance products that were not major medical health insurance, finding that he should be allowed to review recordings of approximately 100,000 sales calls to establish a good faith defense (United States of America v. Timothy Thomas, No. 14-182, M.D. Tenn., 2017 U.S. Dist. LEXIS 152336).

  • September 19, 2017

    Ohio Couple Sentenced, Ordered To Turn Over Home For Insurance Fraud

    COLUMBUS, Ohio — A federal judge in Ohio on Sept. 18 sentenced a couple who owned a home health care company for their roles in an insurance fraud scheme that involved submitting falsified training sheets for nurses and aides and required them to turn over the $1 million home they built with the proceeds of their activities (United States of America v. Riyad Altallaa, et al., No. 16cr128, S.D. Ohio).

  • September 19, 2017

    Pediatric Firm Can Pursue Federal, State False Claims Act Allegations, Judge Says

    NEWARK, N.J. — A firm of pediatric doctors can pursue allegations that a skilled nursing and rehabilitation facility violated the False Claims Act, the New Jersey False Claims Act (NJFCA) and the New York False Claims Act (NYFCA) for unlawfully billing Medicare and Medicaid as primary payers rather than a patient’s private insurance company, a federal judge in New Jersey ruled Sept. 18, finding that the firm sufficiently stated claims under Federal Rule of Civil Procedure 12(b)(6) (United States of America v. Wanaque Convalescent Center, et al., No. 14-6651, D. N.J., 2017 U.S. Dist. LEXIS 150566).

  • September 18, 2017

    3rd Circuit Affirms Dismissal Of Insurer’s Fraud Suit Against Attorneys, Firm

    PHILADELPHIA — A federal judge in Pennsylvania did not err when dismissing an insurance company’s claims that two attorneys and their law firm conspired to submit two fraudulent insurance claims for damage at a church, a Third Circuit U.S. Court of Appeals ruled Sept. 15, finding that the insurer’s claims were barred by judicial privilege (Church Mutual Insurance Company v. Alliance Adjustment Group, et al., No. 16-3302, 3rd Cir., 2017 U.S. App. LEXIS 17864).

  • September 14, 2017

    5th Circuit Finds Woman Was Deliberately Ignorant Of Medicare Fraud Scheme

    NEW ORLEANS — A woman was properly convicted and sentenced to 140 months in prison for illegally billing Medicare more than $250,000 for medical equipment for beneficiaries that was not medically necessary, a Fifth Circuit U.S. Court of Appeals panel ruled Sept. 13, finding that she was deliberately ignorant of her scheme (United States of America v. Tracy Richardson Brown, No. 16-30933, 5th Cir.).

  • September 13, 2017

    Woman Should Not Be Released Pending Appeal Of Fraud Conviction, Judge Says

    SACRAMENTO, Calif. — A woman who was convicted on one count of making false statements to a grand jury as part of its investigation of a scheme involving fraudulent employment insurance benefits and disability claims should not be released on bail pending her appeal, a federal judge in California ruled Aug. 23, finding that the appeal does not raise substantial questions (United States of America v. Harjit Kaur Johal, No. 14-cr-00169-GEB, E.D. Calif., 2017 U.S. Dist. LEXIS 135345).

  • September 13, 2017

    Maryland Appeals Court Finds Woman Waived Continuing Objection Over Fraud Evidence

    ANAPOLIS, Md. — A Maryland appeals court panel on Sept. 11 ruled that a trial court did not err when admitting evidence related to a woman’s fraudulent insurance claim for jewelry that was allegedly stolen, finding that she waived her right to appellate review because her attorney did not renew the objection after evidence outside of the claim was admitted (Phanta U. Daramy v. Maryland, No. 1373, September Term 2016, Md. Spec. App., 2017 Md. App. LEXIS 926).

  • September 12, 2017

    Judge: Dermatologist Convicted On Fraud Charges Does Not Deserve New Trial

    CHICAGO — A federal judge in Illinois on Sept. 11 ruled that a dermatologist who was found guilty of eight counts of health care fraud and eight counts of making false statements related to health care matters is not entitled to a new trial, finding that the evidence presented by the government supported his conviction and that even if statements made by the prosecution during closing arguments were improper, they were not a reversible error (United States of America v. Omeed Memar, No. 15 CR 345, N.D. Ill., 2017 U.S. Dist. LEXIS 146306).

  • September 11, 2017

    California Man Sentenced To 1 Year In Prison For Health Care Fraud Scheme

    NEW ORLEANS — A federal judge in Louisiana on Sept. 7 sentenced a California man to one year in prison for his role in a $38 million health care fraud scheme that involved the sale and distribution of talking glucose meters that were not medically necessary (United States of America v. Geoffrey Ricketts, et al., No. 15cr153, E.D. La.).

  • September 11, 2017

    Judge Trims RICO Claims From Insurers’ Fraud Suit, Finds No Enterprise

    MINNEAPOLIS — A federal judge in Minnesota on Sept. 7 dismissed with prejudice claims asserted by four insurance companies that two chiropractors, their firms and individuals who allegedly recruited patients for the doctors violated the Racketeer Influenced and Corrupt Organizations Act, finding that the companies’ allegations failed to show the existence of an enterprise (Illinois Farmers Insurance Company, et al. v. Timothy W. Guthman, et al., No. 17-270, D. Minn., 2017 U.S. Dist. LEXIS 144866).

  • September 11, 2017

    Judge: Qui Tam Plaintiff’s Insurance Fraud Claims Barred By Public Disclosure

    SAVANNAH, Ga. — A federal judge in Georgia on Sept. 6 dismissed without prejudice a relator’s claims under the qui tam provision of the False Claims Act (FCA) accusing two health care clinics and their providers of failing to submit reimbursements to Medicare, Medicaid and private insurers in 14 states for overpayments the clinics received,  finding that the woman’s claims are barred by public disclosure and that they did not meet the heightened pleading requirements of Federal Rules of Civil Procedure (8)(a) and 9(b) (United States of America, ex rel. Tracy Payton v. Pediatric Services of America, Inc., et al., No. 16-cv-102, S.D. Ga., 2017 U.S. Dist. LEXIS 144289).

  • September 7, 2017

    Judge Dismisses 2 State Law Insurance Fraud Claims Against Woman

    BEAUFORT, S.C. — Relators in a False Claims Act (FCA) lawsuit accusing a number of health care practices and their employees of submitting fraudulent bills for diagnostic services cannot pursue claims against a defendant company’s employee under insurance fraud statutes in California and Illinois, a federal judge in South Carolina ruled Aug. 27, ruling that the relators did not present evidence showing that any claims were submitted to private insurers in those states (United States of America, ex rel. Scarlett Lutz, et al. v. Berkeley Heartlab, Inc., et al., No. 14-cv-00230, D. S.C., 2017 U.S. Dist. LEXIS 138722).

  • September 7, 2017

    Judge Adopts Recommendation To Deny Motion To Dismiss Fraud Indictment

    MINNEAPOLIS — A federal judge in Minnesota on Aug. 31 adopted a magistrate judge’s suggestion to deny a motion filed by three defendants to dismiss an indictment for counts of conspiracy to commit health care fraud and conspiracy to commit mail fraud, finding that the allegations in the indictment are sufficient (United States of America v. Huy Ngoc Nguyen, et al., No. 16-340, D. Minn., 2017 U.S. Dist. LEXIS 140789).

  • September 5, 2017

    6th Circuit: Allowing Agent’s Testimony During Insurance Fraud Trial Was Proper

    DETROIT — A federal judge in Michigan did not err when allowing a U.S. Drug Enforcement Agency agent to testify about wiretapped phone calls he reviewed as part of his investigation of an insurance fraud scheme, a Sixth Circuit U.S. Court of Appeals panel ruled Aug. 30, finding that the testimony was useful to the jury for explaining code words or framing parts of the investigation (United States of America v. Sanyani Edwards, No. 16-1168, 6th Cir., 2017 U.S. App. LEXIS 16828).

  • August 31, 2017

    Appeals Court: Insurance Fraud Defendant Should Be Allowed To Represent Herself

    VENTURA, Calif. — A woman facing four counts of insurance fraud should be allowed to represent herself for her upcoming trial, a California appeals panel ruled Aug. 23, finding that her request was timely and that she acknowledged that she knows her case “inside and out” (People v. Linda Michelle Boggess, No. B277790, Calif. App., 2nd Dist., 6th Div., 2017 Calif. App. Unpub. LEXIS 5795).

  • August 29, 2017

    Allstate Sufficiently States Claims For Fraudulent Billing Scheme, Judge Finds

    DETROIT — A federal judge in Michigan on Aug. 23 ruled that Allstate Insurance Co. sufficiently alleged that a toxicology firm and its employees could be found liable for violating the Racketeer Influenced and Corrupt Organizations Act for submitting fraudulent claims for urine tests that were not medically necessary (Allstate Insurance Company v. Total Toxicology Labs LLC, et al., No. 16-12220, E.D. Mich., 2017 U.S. Dist. LEXIS 134517).

  • August 21, 2017

    Insurer’s Fraud Suit Against Mail Order Pharmacy Is Timely, Judge Rules

    TRENTON, N.J. — An insurance company’s lawsuit accusing a mail order pharmacy of submitting fraudulent claims is timely, a federal judge in New Jersey ruled Aug. 17, finding that the last claim submitted to the company was within the six-year statute of limitations (Horizon Blue Cross Blue Shield of New Jersey v. Focus Express Mail Pharmacy, Inc., et al., No. 17-571, D. N.J., 2017 U.S. Dist. LEXIS 131013).

  • August 18, 2017

    5th Circuit Affirms Doctor’s Convictions For Health Care Fraud, Kickbacks

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Aug. 17 affirmed a jury’s verdict convicting a man of committing health care fraud and paying and receiving kickbacks for approving patients for home health care when they did not need such treatment (United States v. Warren Dailey, No. 16-20517, 5th Cir., 2017 U.S. App. LEXIS 15595).

  • August 17, 2017

    Judge Trims Some Of GEICO’s Claims From Fraudulent Billing Suit

    BOSTON — A federal judge in Massachusetts on Aug. 16 trimmed some claims from a lawsuit brought by the Government Employees Insurance Co. (GEICO) against a chiropractic firm and its owners, finding that while the insurer’s claims were timely and not barred by Massachusetts’ Strategic Litigation Against Public Participation (anti-SLAPP) statute, the company’s claims for civil conspiracy, money had and received, breach of contract and intentional interference with advantageous business relationships were not sufficiently pleaded (Government Employees Insurance Co. v. Barron Chiropractic & Rehabilitation, P.C., et al., No. 16-cv-10642-ADB, D. Mass., 2017 U.S. Dist. LEXIS 130278).