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Mealey's Insurance Fraud

  • December 13, 2018

    Judge Enjoins Pending, Future Arbitration Proceedings Over No-Fault Claims

    NEW YORK — A federal judge in New York on Nov. 16 granted a request by the Government Employees Insurance Co. (GEICO) and its affiliates to enjoin pending and future arbitration proceedings brought by an acupuncturist, a clinic administrator and a couple accusing the insurer of failing to pay claims submitted under New York’s No-Fault Insurance Law, finding that any rulings against the insurer during the pendency of its declaratory judgment suit would result in undue harm (Government Employees Insurance Co., et al. v. Igor Mayzenberg, et al., No. 17-cv-2802, E.D. N.Y., 2018 U.S. Dist. LEXIS 195890).

  • December 13, 2018

    Judge Dismisses State Farm’s Suit Accusing Chiropractors, Clinics Of Fraud

    GREENBELT, Md.— A lawsuit filed by State Farm Mutual Automobile Insurance Co. and State Farm Fire & Casualty Co. (collectively State Farm) accusing two chiropractic clinics and their doctors of submitting fraudulent claims was dismissed by a federal judge in Maryland on Dec. 11 after the judge found that the insurer’s lawsuit failed to distinguish whether the defendants were falsifying patients’ medical records or sending bills for treatment that was medically unnecessary (State Farm Mutual Automobile Insurance Co., et al. v. Carefree Land Chiropractic LLC, et al., No. 18-cv-1279, D. Md., 2018 U.S. Dist. LEXIS 209114)

  • December 13, 2018

    Senior Living Center Asks High Court To Review Ruling In Billing Suit

    WASHINGTON, D.C. — A senior living center petitioned the U.S. Supreme Court on Nov. 20, seeking review of a Sixth Circuit U.S. Court of Appeals ruling reinstating a former employee’s False Claims Act suit, arguing that a divided appellate panel erred in finding that the woman’s allegations satisfied the statute’s requirements for materiality and scienter (Brookdale Senior Living Communities Inc., et al. v. United States of America, ex rel. Marjorie Prather, No. 18-699, U.S. Sup.).

  • December 12, 2018

    Judge Did No Err When Denying Clinic Operator’s Guilty Plea, Panel Says

    CHICAGO — A panel of the Seventh Circuit U.S. Court of Appeals on Nov. 29 affirmed a federal judge in Illinois’ decision to deny a chiropractic clinic owner’s request to withdraw his plea of guilty to one count of health care fraud, finding that he could not raise an ineffective assistance of counsel argument and because he was not entitled to a hearing pursuant to the rulings in Kastigar v. United States, 406 U.S. 441, 92 S. Ct. 1653, 32 L. Ed. 2d 212 (1972) and United States v. Palumbo, 897 F.2d 245 (7th Cir. 1990) (United States v. Steven Paul, No. 17-3606, 7th Cir., 2018 U.S. App. LEXIS 33485).

  • December 12, 2018

    6th Circuit Affirms Doctor’s 19-Year Sentence, Finds Counsel Acted Effectively

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Nov. 26 affirmed a doctor’s 19-year prison sentence for conspiracy to commit health care fraud and conspiracy to distribute and possess with intent to distribute controlled substances, holding that his counsel did not commit a prejudicial error when failing to present evidence that he was in a coma for two months during 2012 and unable to allegedly prescribe the drugs illegally (United States v. Adelfo Pamatmat, No. 17-1611, 6th Cir., 2018 U.S. App. LEXIS 33113).

  • December 12, 2018

    California Appeals Panel Finds Man’s Guilty Plea To Fraud Claim Valid

    SAN FRANCISCO — A California appellate panel on Nov. 29 upheld a man’s sentence of one year in prison and restitution of $10,000 after pleading guilty to one count of insurance fraud, finding that he failed to obtain a probable cause certificate from the trial court (People v. Glenn Josue Barrera-Izaba, No. A151037, Calif. App., 1st Dist., 5th Div., 2018 Cal. App. Unpub. LEXIS 8054).

  • December 12, 2018

    3 Indicted In Scheme To Pay Kickbacks For Compounded Drug Prescriptions

    TULSA, Okla. — The owner of a number of pharmacies and two physicians were indicted in Oklahoma federal court on Dec. 7 for engaging in a scheme involving the payment of illegal kickbacks to physicians who submitted prescriptions for compounded drugs that were later billed to federal health care programs and private insurers for reimbursement (United States v. Christopher P. Parks, et al., No. 18cr251, N.D. Okla.).

  • December 12, 2018

    Doctor Indicted For Billing Medicare For Medically Unnecessary Allergy Tests

    CHICAGO — A doctor who once lived in Illinois was indicted in Illinois federal court Dec. 9 on six counts of health care fraud for submitting bills to Medicare for allergy tests he knew were medically unnecessary (United States v. Omar Garcia, No. 18cr833, N.D. Ill.).

  • December 10, 2018

    Divided Tennessee Appeals Panel Vacates Insurance Fraud Conviction

    KNOXVILLE, Tenn. — A 2-1 panel of the Tennessee Court of Criminal Appeals on Dec. 7 found that a man’s conviction for insurance fraud should be vacated because the evidence presented during trial did not establish that he filed a claim with his insurer and because he did not comply with the terms of the policy by submitting a proof of loss statement (State of Tennessee v. Reuben Eugene Mitchell, No. E2017-01739-CCA-R3-CD, Tenn. App., 2018 Tenn. Crim. App. LEXIS 888).

  • November 28, 2018

    Judge Properly Enhanced Man’s Sentence For Fraud Scheme, 5th Circuit Says

    NEW ORLEANS — A federal judge in Texas did not err when sentencing a law office manager convicted on one count of conspiracy to commit mail fraud and 30 counts of mail fraud as part of his scheme to defraud insurance companies by operating a sham chiropractic clinic to 168 months in prison, a Fifth Circuit U.S. Court of Appeals panel ruled Nov. 16, ruling that the evidence sufficiently showed that the defendant organized the plan and actively recruited individuals to participate (United States v. Earlie Dickerson, Nos. 17-20270, 17-20161, 5th Cir., 2018 U.S. App. LEXIS 32520).

  • November 27, 2018

    Federal Judge Stays 2,300 State Court Cases Against Insurer Over No-Fault Claims

    NEW YORK — A federal judge in New York on Nov. 26 stayed 2,300 cases in state court and 20 arbitration proceedings initiated by medical providers and medical device suppliers of a Brooklyn, N.Y., clinic that are seeking $3.2 million worth of claims for reimbursement under the state’s no-fault benefits program from State Farm Mutual Automobile Insurance Co. and State Farm Fire & Casualty Co., finding that the court had the authority to do so under the in aid of jurisdiction exception to the Anti-Injunction Act (AIA) (State Farm Mutual Automobile Insurance Co., et al. v. Jules Parisien, M.D., et al., No. 18-CV-289, E.D. N.Y., 2018 U.S. Dist. LEXIS 199566).

  • November 15, 2018

    5th Circuit Upholds Man’s Conviction For Role In Insurance Fraud Scheme

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 14 affirmed a man’s convictions for charges of conspiracy to commit mail and wire fraud as part of a larger scheme to defraud insurance companies by filing claims for automobile accidents that never occurred, ruling that a federal judge in Texas did not err when denying his motion to vacate the sentence and hold an evidentiary hearing regarding whether the government threatened to charge his mother with perjury (United States v. Derrick L. Jimerson, No. 16-41262, 5th Cir., 2018 U.S. App. LEXIS 32218).

  • November 15, 2018

    Allstate Sues Chiropractors, Clinics Over Alleged Fraud Scheme

    DETROIT — Allstate Insurance Co. and two of its affiliates on Nov. 8 sued two chiropractors and a number of clinics in a Michigan federal court, claiming that they engaged in a scheme to submit fraudulent bills for benefits under Michigan’s No-Fault Act that were medically unnecessary or not performed (Allstate Insurance Co., et al. v. Derek L. Bittner D.C., et al., No. 18-13484, E.D. Mich.).

  • November 12, 2018

    No Objection To Later Trial Date Over Charges Of Fraud On Crop Insurance

    LEXINGTON, Ky. — The U.S. government in a Nov. 8 brief says it does not object to a farmer’s motion in a Kentucky federal court to continue trial to a later date over accusations that he submitted false reports regarding federally reinsured crop insurance policies but deferred to the court’s “sound judgment” (United States v. Christopher G. Hickerson, No. 18-cr-00111, E.D. Ky.).

  • November 12, 2018

    Panel: Some Cross-Claims From Lawyer Accused Of Insurance Fraud Properly Stricken

    LOS ANGELES — A California appeals panel on Nov. 9 upheld a trial court judge’s ruling dismissing cross-claims brought by a lawyer accused of insurance fraud, finding that an insurance company’s subpoenas seeking the attorney’s deposition in three unrelated personal injury actions did not constitute an abuse of process under the state’s anti-SLAPP (strategic lawsuit against public participation) statute or constitute an unfair business practice in violation of California Business and Professions Code Section 17200 (Dennis Gerald Geselowitz v. Allstate Insurance Co., No. B278637, Calif. App., 2nd Dist., 3rd Div., 2018 Cal. App. Unpub. LEXIS 7605).

  • November 12, 2018

    Judge Denies Health Care Fraud Defendant’s Motion To Suppress Evidence From Emails

    NEW YORK — A federal judge in New York on Nov. 9 denied a motion to suppress filed by a man accused of participating in a health care fraud scheme, finding that search warrants executed for three email accounts were not overbroad and that the man had no reasonable expectation of privacy for the accounts (United States v. Paul J. Mathieu, et al., No. 16 cr 763, S.D. N.Y., 2018 U.S. Dist. LEXIS 192281).

  • November 7, 2018

    Farmer Seeks Later Trial Date Over Charges Of Fraud On Crop Insurance

    LEXINGTON, Ky. — Citing a “large volume of discovery,” a farmer accused by the U.S. government of submitting false reports regarding federally reinsured crop insurance policies on Nov. 2 asked a Kentucky federal court to continue trial to sometime after January (United States v. Christopher G. Hickerson, No. 18-cr-00111, E.D. Ky.).

  • November 6, 2018

    Ophthalmologist Agrees To Pay $2M For Fraudulently Billing Medicare, Medicaid

    NEW YORK — An ophthalmologist and his practice on Nov. 1 agreed to pay $2 million to the federal government to resolve claims brought in New York federal court that he violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for testing that was done so poorly that it lacked any diagnostic value (United States v. Metropolitan Retina Associates Inc., et al., No. 18-cv-9146, S.D. N.Y.).

  • November 6, 2018

    Farmer Charged With Fraud Scheme Against Federal Crop Reinsurer

    LEXINGTON, Ky. — The U.S. government in a Nov. 1 indictment filed in a Kentucky federal court accuses a farmer of fraudulently submitting statements to a government agency that reinsures his crops (United States v. Keith Foley, No. 18-cr-00154, E.D. Ky.).

  • November 2, 2018

    Cardiologist Sentenced To 42 Months In Prison For Health Care Fraud

    LONDON, Ky. — A federal judge in Kentucky on Nov. 1 sentenced a cardiologist to 42 months in prison and ordered him to pay a $50,000 fine and pay $257,515 in restitution to Medicare, Medicaid and private insurers after he was found guilty of health care fraud for implanting pacemakers in patients who did not need them (United States v. Anis Chalhoub, M.D., No. 16-cr-00023-GFHT-HAI, E.D. Ky.).