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Mealey's Insurance Fraud

  • July 15, 2020

    Behavioral Health Services Providers To Resolve False Claims Act Suits For $122M

    WASHINGTON, D.C.  — An inpatient behavioral health management and administrative services company, one of its entities and one of its facilities in Georgia have agreed to pay $122 million to resolve allegations in 19 lawsuits that say the companies violated the False Claims Act (FCA) by fraudulently billing Medicare for services that were unnecessary or not provided and by illegally paying beneficiaries to use the Georgia facility, the U.S Department of Justice announced July 10.

  • July 14, 2020

    Management Company, 27 Nursing Facilities To Pay $16.7M For False Billing Scheme

    WASHINGTON, D.C. — The U.S. Department of Justice announced July 13 that a management company and 27 skilled nursing facilities in California have agreed to pay $16.7 million to partially resolve allegations in two lawsuits brought under the qui tam provisions of the False Claims Act (FCA) that accuse them of submitting claims to Medicare for “ultra high” rehabilitation services for patients that were not medically necessary.

  • July 14, 2020

    Panel Vacates Man’s Arson, Insurance Fraud Convictions, Orders New Trial

    ST. PAUL, Minn. — A Minnesota appeals panel on July 13 vacated a man’s convictions for conspiracy to commit insurance fraud and arson and remanded the case for a new trial on a lesser charge of arson and conspiracy to commit insurance fraud after finding that a trial court judge erred when compelling the defendant’s wife to testify without his consent and erred when instructing the jury (Minnesota v. Deitrick Aaron Gill, A19-1173, Minn. App., 2020 Minn. App. Unpub. LEXIS 574).

  • July 14, 2020

    Former Oncologist’s Health Conditions Do Not Warrant Compassionate Release

    DETROIT — A former oncologist who is serving a 45-year prison sentence after pleading guilty to submitting false bills to Medicare and other insurers for cancer treatments that were medically unnecessary or not provided should not be given compassionate release based on his age, his diagnoses of type-2 diabetes and diabetic neuropathy and the COVID-19 pandemic because they are not compelling reasons, a federal judge in Michigan ruled July 10 (United States v. Farid Fata, No. 13-cr-20600, E.D. Mich., 2020 U.S. Dist. LEXIS 121361).

  • July 13, 2020

    Hospice Provider To Pay $3.2M For Billing Insurers For Unqualified Patients

    FORT MYERS, Fla. — A Florida-based hospice care provider on July 9 entered into an agreement in federal court in Florida in which it agreed to pay $3.2 million to resolve allegations asserted in a suit brought under the qui tam provisions of the False Claims Act (FCA) that accused it of billing insurers for hospice services provided to patients who did not qualify for them and that were medically unnecessary from July 1, 2012, to June 30, 2016 (U.S. ex rel. Margaret Peters v. Hope Hospice and Community Services LLC, et al., No. 16-cv-6- FtM-99MRM, M.D. Fla.).

  • July 07, 2020

    Judge Finds Pandemic No Reason To Convert Fraud Defendants’ Prison Sentences

    NEW YORK — A federal judge in New York on July 6 denied motions from two fraud defendants serving prison sentences of 25 years and 15 years, respectively, finding that while their diagnoses of hypertension and other medical conditions may put them at a higher risk of suffering severe complications if they contract COVID-19, the risk does not present a compelling reason to convert their sentences to home confinement (United States v. Michael Danilovich, No. 12-CR-171-02, 2020 U.S. Dist. LEXIS 118069, United States v. Mikhail Zemlyansky, No. 12-CR-171-01, S.D. N.Y, 2020 U.S. Dist. LEXIS 118098).

  • July 01, 2020

    Conviction, Expert Ruling Upheld In Medicare Fraud Case Against Laser Eye Doctor

    ATLANTA — A trial court did not abuse its broad discretion in limiting the testimony of a medical expert for an ophthalmologist who was eventually convicted of health care fraud for conducting unnecessary and unhelpful procedures on hundreds of mostly elderly patients, the 11th Circuit U.S. Court of Appeals ruled June 29 in affirming the doctor’s conviction (United States v. David Ming Pon, No. 17-11455, 11th Cir., 2020 U.S. App. LEXIS 20103).

  • June 25, 2020

    6th Circuit Says Fraud Defendant’s 6-Month Probation Sentence Not Too Long

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on June 22 affirmed a federal judge in Michigan’s resentencing of a woman who was found guilty of engaging in a scheme to submit fraudulent unemployment insurance claims, holding that her sentencing of six months’ probation was not  “unreasonably long” because it was less severe than the low end of the proposed sentencing guidelines range (United States v. Nakita Washington, No. 20-1069, 6th Cir., 2020 U.S. App. LEXIS 19469).

  • June 22, 2020

    Judge Refuses To Reduce Heath Care Fraud Defendant’s Sentence Due To COVID-19

    SAN DIEGO — A federal judge in California on June 19 refused to convert the remaining four months of a man’s prison sentence to home confinement after he pleaded guilty to his involvement in a health care fraud scheme, finding that his diagnoses of being prediabetic and borderline obese do not meet the requirements of the Centers of Disease Control and Prevention for increased risk of severe complications if he contracted COVID-19 (United States v. Fernando Valdes, No. 15cr2822-CAB, S.D. Calif., 2020 U.S. Dist. LEXIS 107797).

  • June 22, 2020

    Judge Denies Man’s Request To Transfer Criminal Health Care Fraud Suit

    HARTFORD, Conn.  — A federal judge in Connecticut on June 18 denied a motion to transfer filed by a former substance abuse clinic owner who is accused of conspiracy to commit health care fraud, health care fraud and wire fraud, finding that California is not a better venue for the action and that the novel coronavirus pandemic does not weigh in favor of transfer (United States v. R. Jeffrey Yates, No. 19-cr-266, D. Conn., 2020 U.S. Dist. LEXIS 107339).

  • June 18, 2020

    Insurers’ Suit Over Clinics’ Ownership, Billing Scheme Survives Dismissal

    ORLANDO, Fla. — A federal judge in Florida on May 22 denied motions to dismiss a lawsuit brought by State Farm Mutual Automobile Insurance Co. and State Farm Fire & Casualty Co. claiming that two clinics and their owners violated the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) by submitting claims for no-fault personal injury protection (PIP) benefits from clinics that were not wholly owned by a licensed physician as required by state law, holding that the insurers sufficiently stated claims for relief (State Farm Mutual Automobile Insurance Co., et al. v. Advantacare of Florida Inc., et al., No. 19-cv-1837-Orl-41LRH, M.D. Fla., 2020 U.S. Dist. LEXIS 92302).

  • June 12, 2020

    Man’s Conviction, Amount Of Loss From Fraud Scheme Upheld By 11th Circuit

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on May 28 upheld a man’s conviction and 85-month prison sentence for his role in an insurance fraud scheme that involved the paying of kickbacks between two clinic owners who submitted bills to Blue Cross Blue Shield of Florida for medical services that were never provided, finding that a federal judge in Florida did not err when admitting evidence and when calculating the amount of loss (United States v. Louis Robaina, No. 19-11171, 11th Cir., 2020 U.S. App. LEXIS 16955).

  • June 10, 2020

    4th Circuit Finds No Error In Introducing Evidence Of Previous Fire

    RICHMOND, Va. — A Fourth Circuit U.S. Court of Appeals panel on June 9 found that a federal judge in West Virginia did not abuse his discretion when allowing evidence regarding a prior fire at a fraud defendant’s Wharncliffe, W.Va., home, holding that the evidence of the fire was inextricably intertwined with the fraud and conspiracy allegations at issue in the case (United States v. James Edward Lester, No. 19-4333, 4th Cir., 2020 U.S. App. LEXIS 18129).

  • June 09, 2020

    Kansas Appeals Panel Affirms Denial Of Insurance Agent’s New Trial Request

    KANSAS CITY, Kan. — A Kansas appeals panel on June 5 affirmed the denial of a convicted insurance agent’s motion for a mistrial and new trial, holding that while she preserved the issue of whether a conversation between a fraud investigator and a juror was prejudicial, her arguments were precluded by the invited error doctrine (Kansas v. Jodi R. Pappada, No. 120,760, Kan. App., 2020 Kan. App. Unpub. LEXIS 376).

  • June 08, 2020

    6th Circuit:  Public Disclosure Bar Fatal To Nursing Home’s Alleged Hospice Fraud

    CINCINNATI — The dismissal of a woman’s qui tam lawsuit brought under the False Claims Act (FCA) that accused a nursing home of fraudulently billing Medicare and Medicaid for hospice care for patients who were improperly categorized as terminally ill was affirmed by a Sixth Circuit U.S. Court of Appeals panel on June 3 after the panel found that the woman’s allegations were precluded by pre- and post-amendments to the statute’s public disclosure bar (United States, ex rel. Kathi Holloway v. Heartland Hospice Inc., et al., No. 19-3646, 6th Cir., 2020 U.S. App. LEXIS 17529).

  • June 01, 2020

    Fraud Defendant’s Motion To Convert Sentence To Home Confinement Denied

    NEWARK, N.J. — A federal judge in New Jersey on May 29 denied a health care fraud defendant’s motion to convert the remainder of his 50-month prison sentence to home confinement and probation in light of the novel coronavirus pandemic, ruling that the defendant’s medical history of obesity and hypertension does not put him at a higher risk of contracting the virus and that his role in the $3.5 million fraudulent billing scheme does not support his release from prison (United States v. Brian Catanzarite, No. 18-0362, D. N.J., 2020 U.S. Dist. LEXIS 94478).

  • May 29, 2020

    Panel Finds Counsel Was Effective During Fraud Defendant’s Plea Hearing

    HARRISBURG, Pa. — A Pennsylvania appeals court panel on May 26 affirmed a ruling denying a physician’s motion for relief under the Post Conviction Relief Act (PCRA), finding that there was not enough evidence to show that his counsel was ineffective during a hearing on his guilty plea for submitting fraudulent bills to insurers (Pennsylvania v. Daniel Raymond Nevarre, 1305 WDA 2019, 2020 Pa. Super. Unpub. LEXIS 1762).

  • May 21, 2020

    Judge Dismisses Suit Claiming Off-Label Marketing Violated False Claims Act

    WASHINGTON, D.C. — A federal judge in the District of Columbia on May 19 dismissed without prejudice a relator’s False Claims Act (FCA) lawsuit claiming that Vanda Pharmaceuticals Inc.’s off-label promotion of an atypical antipsychotic and a drug used to treat 24-hour non-sleep disorder in blind patients resulted in the submission of fraudulent claims to Medicare and Medicaid (United States, ex rel. Richard Gardner v. Vanda Pharmaceuticals Inc., No. 17-cv-00464, D. D.C., 2020 U.S. Dist. LEXIS 87790).

  • May 19, 2020

    Judge:  Fraud Defendant’s Evidence Regarding Legitimate Therapy Services Irrelevant

    NEW YORK — A federal judge in New York on May 15 granted the federal government’s motion in limine to preclude a woman accused of health care fraud from presenting evidence during a trial demonstrating that she had performed legitimate therapy sessions with developmentally challenged children, finding that the information is irrelevant (United States v. Marina Golfo, No. 19-cv-00095, E.D. N.Y., 2020 U.S. Dist. LEXIS 85377).

  • May 18, 2020

    5th Circuit Panel Upholds Convictions, Sentences In $3.5M Medicare Fraud Scheme

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on May 15 affirmed the convictions of two participants in a $3.5 million Medicare fraud scheme stemming from the operation of a home health care services company for elderly patients, as well as the sentences of the two remaining participants, holding that the evidence was sufficient to support the convictions and that the sentences were proper (United States v. Paul Emordi, et al., No. 19-10400, 5th Cir., 2020 U.S. App. LEXIS 15567).