Mealey's Insurance Fraud

  • February 15, 2018

    New York Appeals Court Affirms Evidentiary Rulings Entered During Arson Trial

    ROCHESTER, N.Y.  — A New York appeals court panel on Feb. 9 affirmed rulings by a trial court judge that denied a defendant’s motion to suppress statements he made to police after a fire destroyed a rental property he owned, as well as evidence on his parole status, finding that exclusion of the evidence would not have resulted in an acquittal (People v. Samuel F. Crawford, No. 1482 KA 14-01983, N.Y. Sup., App. Div., 4th Dept., 2018 N.Y. App. Div. LEXIS 953).

  • February 15, 2018

    Magistrate Judge: Insurer’s Amended Complaint Adequately States RICO Claim

    DENVER — A federal magistrate judge in Colorado on Feb. 12 recommended granting an insurance company’s motion to file a second amended complaint, finding that it sufficiently alleged that an enterprise exists under the Racketeer Influenced and Corrupt Organizations Act against an insurance adjuster accused of inflating a policyholder’s appraisal for roof damage following a hailstorm (Church Mutual Insurance Company v. Phillip Marshall Coutu, et al., No. 17-cv-00209-RM-NYW, D. Colo., 2018 U.S. Dist. LEXIS 22569).

  • February 14, 2018

    Judge Allows Insurer To Amend Complaint To Provide Details Of Fraud Scheme

    FLINT, Mich. — A statutorily created insurance program that provides insurance coverage for pedestrians struck by vehicles and passengers in automobile accidents can file a second amended complaint that provides additional details of a fraudulent scheme that submitted bills to insurance companies, a federal judge in Michigan ruled Feb. 13 (Michigan Automobile Insurance Placement Facility v. New Grace Rehabilitation Center PLLC, et al., No. 17-11007, E.D. Mich., 2018 U.S. Dist. LEXIS 22953).

  • February 12, 2018

    2nd Circuit Finds Investors To STOLI Policies Were Victims, Affirms Restitution

    NEW YORK — A federal judge in Connecticut did not err when finding that investors in three stranger obtained life insurance (STOLI) policies were victims under the Mandatory Victim Restitution Act (MVRA) and ordering a man who pleaded guilty to insurance fraud to pay $1.9 million in restitution, a Second Circuit U.S. Court of Appeals panel held Feb. 9, explaining that investors would not have given the defendant their money if they were aware of the scheme (United States of America v. David Quatrella, No. 17-1786-cr, 2nd Cir., 2018 U.S. App. LEXIS 3189).

  • February 9, 2018

    Surgeon Sentenced To 196 Months In Prison For Fraudulent Billing Scheme

    NEW YORK — A surgeon who was found guilty of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering was sentenced by a federal judge in New York on Feb. 7 to 196 months in prison and ordered to pay $7.2 million in restitution (United States of America v. Syed I. Ahmed, No. 17cr277, E.D. Mich.).

  • February 9, 2018

    Man’s Motion To Vacate Sentence Over Fraud Scheme Denied By Judge

    MADISON, Wis. — Three attorneys who represented a man during his prosecution for submitting fraudulent automobile insurance claims provided him effective assistance, a federal judge in Wisconsin ruled Feb. 7 in denying a motion to vacate his sentence, holding that any issues that arose during the proceedings stemmed from his dishonesty with the court (John E. Henricks III v. United States of America, No. 17-cv-630, W.D. Wis., 2018 U.S. Dist. LEXIS 19668).

  • February 9, 2018

    11th Circuit Overturns 1 Chiropractor’s Sentence, Affirms Fraud Convictions

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Jan. 31 found that the government presented sufficient evidence to warrant the convictions of three chiropractors who were found guilty in a fraud scheme involving personal injury protection (PIP) coverage, but overturned one defendant’s sentence on the ground that the judge erred when calculating the amount of loss (United States of America v. Joel Antonio Simon Ramirez, et al., No. 14-14689, 11th Cir., 2018 U.S. App. LEXIS 2717).

  • February 7, 2018

    Doctor Pleads Guilty To Fraudulent Billing, Dispensing Controlled Substances

    BOWLING GREEN, Ky. — A doctor pleaded guilty on Feb. 5 in Kentucky federal court to intentionally distributing and dispensing controlled substances outside the course of professional practice and submitting fraudulent bills to Medicare and Medicaid and agreed to serve eight years in prison (United States of America v. Charles F. Gott, No. 15cr13, W.D. Ky.).

  • February 1, 2018

    5th Circuit: Evidence Does Not Support Conspiracy, Medicare Fraud Convictions

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Jan. 30 overturned the conviction and sentencing of a doctor and home health care agency owner found guilty for conspiracy to commit health care fraud and health care fraud, holding that the government did not present sufficient evidence to support the jury’s findings (United States of America v. Pramela Ganji, et al., No. 16-31119, 5th Cir., 2018 U.S. App. LEXIS 2279).

  • January 29, 2018

    Pennsylvania Panel Finds Jury Was Properly Instructed About Prescription Rules

    PHILADELPHIA — A Pennsylvania appeals court panel on Jan. 26 affirmed a doctor’s sentence for illegally prescribing opioid medications and submitting fraudulent bills to insurance companies after finding that the jury was properly instructed about the state’s standards for properly prescribing the drugs (Commonwealth of Pennsylvania v. Lawrence P. Wean, Nos. 1165 EDA 2016, 1167 EDA 2016, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 240).

  • January 29, 2018

    2nd Circuit Orders Judge To Recalculate Loss From Insurance Fraud Scheme

    NEW YORK — A federal judge in New York was ordered by a Second Circuit U.S. Court of Appeals panel on Jan. 26 to recalculate the amount of loss an insurance company incurred as part of a fraud scheme, finding that the judge erred when including $15,228 in his calculations (United States of America v. Julian Brown, No. 16-2841-cr, 2nd Cir., 2018 U.S. App. LEXIS 1943).

  • January 29, 2018

    Judge Refuses To Dismiss Indictment Over Illegal Acquisition Of Insurance

    HARRISBURG, Pa. — A federal judge in Pennsylvania on Jan. 24 ruled that the government adequately alleges that a man should face charges of mail fraud, conspiracy to commit mail fraud and conspiracy to defraud the United States as a result of his role in a scheme to illegally obtain insurance for buses that were part of a commercial transportation company (United States of America v. Yalin Liu, No. 16cr42, M.D. Pa., 2018 U.S. Dist. LEXIS 11243).

  • January 26, 2018

    11th Circuit Upholds Couple’s Conviction For $12M Insurance Fraud Scheme

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Jan. 23 refused to vacate a couple’s convictions and sentences for a $12 million insurance fraud scheme that involved their clinics overcharging Universal Health Care Insurance Co. for treatment of patients with HIV, finding that the judge did not err when admitting evidence and calculating the amount of loss sustained by the insurer (United States of America v. Gladys Fuertes, et al., No. 15-12928, 11th Cir., 2018 U.S. App. LEXIS 1900).

  • January 25, 2018

    Judge Affirms Man’s Conviction, Sentence For Auto Accident Scheme

    DALLAS — A federal judge in Texas on Jan. 23 denied a man’s motion to vacate his conviction and sentence for conspiracy to commit health care fraud for orchestrating a scheme to submit false bills to insurers for injuries occurring from automobile accidents, finding that his right to due process was not violated (Frenchitt Su-Dell Collins v. United States of America, No. 16-cv-1472-K, N.D. Texas, 2018 U.S. Dist. LEXIS 10997).

  • January 23, 2018

    Government Cannot Introduce Evidence Of Insurance Payments During Fraud Trial

    BILLINGS, Mont. —The government cannot introduce evidence regarding the extent of damages, injuries and insurance payments that resulted from a December 2012 explosion that was caused when a trucking company was hauling natural gas condensate, a federal judge in Montana ruled Jan. 22, finding that the evidence has little probative value (United States of America v. Woody’s Trucking LLC, et al., No. CR 17-138, D. Mont., 2018 U.S. Dist. LEXIS 9749).

  • January 22, 2018

    7th Circuit Upholds Fraud Sentences For Medical Office Manager, Billing Agent

    CHICAGO — A federal judge in Illinois did not err when sentencing a home health care office manager and billing specialist following their convictions for health care fraud and conspiracy to commit health care fraud, a Seventh Circuit U.S. Court of Appeals panel ruled Jan. 19, holding that the reasoning behind the sentences was correct (United States of America v. Rick E. Brown, et al., Nos. 15-3117, 15-3261, 7th Cir., 2017 U.S. App. LEXIS 1284).

  • January 18, 2018

    Judge Refuses To Remand Fraud Suit For Improper Service To Defendant Doctor

    PHILADELPHIA — A federal judge in Pennsylvania on Jan. 12 denied a motion to remand filed by Aetna Inc. and Aetna Health Management LLC, finding that their attempt to provide service to a defendant doctor accused of conspiring to submit claims for an opioid-based pain medication for cancer patients was improper because the complaint was not sent to a location with a person who could accept service on his behalf (Aetna Inc., et al. v. Insys Therapeutics Inc., et al., No. 17-4812, E.D. Pa., 2018 U.S. Dist. LEXIS 6943).

  • January 17, 2018

    Judge Finds Indictment Sufficiently Alleges Scheme To Defraud Insurer, Government

    BILLINGS, Mont. — A federal judge in Montana on Jan. 16 denied a motion to dismiss a 14-count indictment filed by a transportation company and its owner accused of concealing from their insurer that they were transporting explosives, finding that the allegations in the indictment sufficiently support conviction (United States of America v. Woody’s Trucking LLC, et al., No. CR 17-138, D. Mont., 2018 U.S. Dist. LEXIS 6816).

  • January 16, 2018

    Judge Abstains From Workers’ Compensation Coverage Dispute

    CHARLESTON, S.C. — A federal judge in South Carolina on Jan. 11 granted a construction company’s motion to reconsider a ruling denying its motion to dismiss, finding that the South Carolina Workers’ Compensation Commission (SCWCC) should determine if an insurance policy issued to the company was in place at the time a man’s claim was filed (Owners Insurance Company v. Warren Mechanical LLC, No. 16-cv-0668-DCN, D. S.C., 2018 U.S. Dist. LEXIS 5187).

  • January 16, 2018

    Appeals Court: Perjury, Workers’ Compensation Fraud Sentences Were Authorized

    LOS ANGELES — A California appeals court panel on Jan. 11 found that a man found guilty of workers’ compensation fraud should serve three years because the sentence is allowed by the California Insurance Code and because the defendant did not object to the sentence to the trial court judge (People v. Luis Hernandez, No. B279922, Calif. App., 2nd Dist., 5th Div., 2018 Calif. App. Unpub. LEXIS 265).