Mealey's Insurance Fraud

  • August 12, 2019

    5th Circuit Upholds Denial Of Fraud Defendant’s Requested Jury Instruction

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Aug. 8 upheld a federal judge in Texas’ ruling denying an insurance fraud defendant’s request for a good faith jury instruction, holding that the defendant failed to show that the omission of a jury instruction impaired his good faith defense (United States v. David Roy Williams, No. 18-11184, 5th Cir., 2019 U.S. App. LEXIS 23848).

  • August 07, 2019

    Judge Finds Insurance Agency May Have Breached Duty To Procure Sufficient Policy

    NEW ORLEANS — A federal judge in Louisiana on Aug. 6 denied an insurance agency’s motion for summary judgment on claims brought by a couple claiming that it should indemnify them for damages from a fire that destroyed their home, finding that genuine disputes exist as to whether the agency breached its duty to procure a policy that would have covered the home (GeoVera Specialty Insurance Co. v. Mariette Joachin, et al., No. 18-7577, E.D. La., 2019 U.S. Dist. LEXIS 131033).

  • August 05, 2019

    Panel Affirms Judgment For Insurer In Fire Case After Upholding Expert Rulings

    ST. LOUIS — Physical testing at the scene of a fire that destroyed a building was not required for an insurer’s expert witnesses to opine on when the blaze started, the Eighth Circuit U.S. Court of appeals ruled Aug. 1 in affirming denial of a new trial for a Missouri couple (Allstate Indemnity Company v. Joseph Dixon, et al., No. 18-1948, 8th Cir., 2019 U.S. App. LEXIS 23021).

  • August 02, 2019

    Rulings Quashing Bill Of Information In Insurance Fraud Suit Overturned On Appeal

    NEW ORLEANS — A Louisiana appeals panel on July 31 vacated a ruling quashing a bill of information charging four individuals with insurance fraud, finding that the allegations in the document were not deficient and that the court had jurisdiction over the suit (State of Louisiana v. Colleen Brown, et al., No. 2019-KA-0281, La. App., 4th Cir., 2019 La. App. LEXIS 1327).

  • July 31, 2019

    Panel Upholds $13.4M Restitution Order For Workers’ Compensation Premium Fraud

    SANTA ANA, Calif. — A California appeals panel on July 23 affirmed a trial court judge’s ruling ordering a man convicted on 33 counts of insurance premium fraud to pay $13.4 million in restitution, finding that the judge properly calculated the amount based on information presented by the defendant’s expert (People v. Michael Vincent Petronella, No. G054524, Calif. App., 4th Dist., 3rd Div., 2019 Cal. App. Unpub. LEXIS 4916).

  • July 30, 2019

    Judge: Record Unclear If Remodeling Company Intended To Defraud Insurer

    JOHNSTOWN, Pa. — A federal judge in Pennsylvania on July 29 denied a workers’ compensation insurance provider’s motion for partial summary judgment on its claim that a remodeling company violated the Pennsylvania Insurance Fraud statute, ruling that genuine disputes exist as to whether the company intended to defraud the insurer (American Builders Insurance Co. v. Custom Installations Contracting Services Inc., et al., No. 15-cv-295, W.D. Pa., 2019 U.S. Dist. LEXIS 125373).

  • July 29, 2019

    Judge Remands Insurance Fraud Suit Over AbbVie’s Marketing Of Humira

    SAN FRANCISCO — A federal judge in California on July 24 remanded a lawsuit accusing AbbVie Inc. of violating California’s Insurance Fraud Prevention Act when marketing Humira by paying kickbacks to doctors who prescribed the autoimmune disorder treatment, finding that the state is a real party in interest (California ex rel. Lazaro Suarez v. AbbVie Inc., No. 18-cv-06392-JD, N.D. Calif., 2019 U.S. Dist. LEXIS 124463).

  • July 22, 2019

    DOJ:  Podiatrist Sentenced To 1 Year, 1 Day In Prison For Fraud

    NEW YORK — The U.S. Department of Justice announced that a federal judge in New York on July 19 sentenced a podiatrist who pleaded guilty to health care fraud to one year and one day in prison for his role in a scheme that involved fraudulently billing insurance companies for services that were never performed (United States v. Hal Abrahamson, No. 18-cr-314, E.D. N.Y.).

  • July 22, 2019

    5th Circuit Upholds Dismissal Of Dentist, Office Employees’ False Claims Act Suit

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on July 19 upheld the dismissal of a False Claims Act (FCA) suit brought by a dentist and an office employee accusing a dental services practice of submitting false bills to Medicare, ruling that a federal judge in Texas did not err when dismissing their suit after they filed to timely amend their action to include federal retaliation claims under the act (United States, ex rel. Philip M. Lin, et al. v. NCDR LLC, et al., No. 18-50653, 5th Cir.).

  • July 19, 2019

    7th Circuit:  Government Properly Calculated Amount Of Loss From Fraud Scheme

    CHICAGO — A Seventh Circuit U.S. Court of Appeals panel on July 18 affirmed a chiropractor’s five-year prison sentence for submitting fraudulent bills to Medicare and private insurers for deceased patients or treatments that were never provided, finding that the government did not err when finding that the man’s scheme resulted in an amount of loss of $4 million (United States v. Henry Posada, No. 18-1586, 7th Cir., 2019 U.S. App. LEXIS 21299).

  • July 18, 2019

    Jury Finds Brother, Sister Guilty In $7.8M Health Care Fraud Scheme

    BIRMINGHAM, Ala. — A federal jury in Alabama on July 16 unanimously found that a doctor and nurse were guilty of submitting $7.8 million in bills for Medicare and private insurance companies for prescriptions for opioids and allergy immunotherapy treatments that were medically unnecessary (United States v. Patrick Emeka Ifediba, et al., No. 18-cr-0103-RDP-JEO, N.D. Ala.).

  • July 17, 2019

    Judge Limits Expert’s Testimony About Fraud Defendant’s Prescribing Habits

    BIRMINGHAM, Ala. — A federal judge in Alabama on July 15 granted in part a motion to exclude testimony from an insurance fraud defendant’s expert regarding state-specific standards on the prescribing of opioids, finding that the doctor had not reviewed the information when forming his opinion (United States v. Patrick Emeka Ifediba, et al., No. 18-cr-0103-RDP-JEO, N.D. Ala., 2019 U.S. Dist. LEXIS 116826).

  • July 16, 2019

    Woman Sentenced For Using Stolen Identities As Part Of Medicaid Scheme

    NEW HAVEN, Conn. — A federal judge in Connecticut on July 12 sentenced a woman to seven months in prison and ordered her to pay $1.3 million in restitution after she pleaded guilty for her role in a scheme to submit fraudulent bills to Medicaid for psychotherapy services that were never provided using the stolen identities of Medicaid beneficiaries (United States v. Nikkita Chesney, No. 18cr257, D. Conn.).

  • July 12, 2019

    Chiropractor’s Conviction, Sentence For Workers’ Compensation Fraud Upheld

    FRESNO, Calif. — A California appeals panel on July 11 upheld a chiropractor’s conviction and sentence for conspiracy to commit insurance fraud for his role in a scheme that involved the submission of fraudulent bills for workers’ compensation benefits that were prepared pursuant to a predetermined protocol that included incorrect coding for treatments that were not rendered or medically necessary (People v. Dolphus Dwayne Pierce II, No. F074602, Calif. App., 5th Dist., 2019 Calif. Unpub. LEXIS 4639).

  • July 10, 2019

    Texas Panel Finds Defrauded Insurer Was Properly Identified In Indictment

    HOUSTON — A Texas appeals court panel on July 9 upheld a man’s conviction for insurance fraud after finding that his insurer was properly named in his indictment and that any variations in the company’s name in evidence that was presented during trial were immaterial (Mohamed Saleh Awad v. Texas, No. 14-18-00250-CR, Texas App., 14th Dist., 2019 Tex. App. LEXIS 5687).

  • July 09, 2019

    Magistrate Judge Marginally Trims Records Request In Subpoena Issued To Attorney

    DETROIT — A federal magistrate judge in Michigan on July 2 ordered a nonparty attorney accused of referring individuals injured in automobile accidents to clinics that allegedly submitted fraudulent bills to State Farm Mutual Automobile Insurance Co. to produce a majority of the records the insurer requested in a subpoena, holding that evidence presented by the company could support the inference that he is the center of the scheme (State Farm Mutual Automobile Insurance Company v. Elite Health Centers Inc., et al., No. 16cv13040, E.D. Mich., 2019 U.S. Dist. LEXIS 110767).

  • July 08, 2019

    State Farm’s Allegations Over Fraud Scheme Are Sufficient, Judge Rules

    MIAMI — A federal judge in Florida on June 11 denied motions to dismiss filed by two doctors and two medical clinics accused by State Farm Mutual Automobile Insurance Co. and State Farm Fire and Casualty Co. (State Farm) of engaging in a scheme to submit fraudulent claims for personal injury benefits, holding that the insurer’s allegations satisfy the heightened pleading requirement of Federal Rule of Civil Procedure 9(b) and that the company’s amended complaint is not a shotgun pleading (State Farm Mutual Automobile Insurance Company, et al. v. Health and Wellness Services Inc., et al., No. 18-21325-Civ-Scola, S.D. Fla., 2019 U.S. Dist. LEXIS 105269).

  • July 02, 2019

    Man Sentenced For Fraudulent Receipt Of Medicare Benefits

    HARRISBURG, Pa. — A federal judge in Pennsylvania on June 27 sentenced a man to two years’ probation and ordered him to pay $29,337 in restitution after he pleaded guilty to fraudulently receiving Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits from 2014 to 2018 (United States v. Nagy M. Abdelhamed, No. 18cr314, M.D. Pa.).

  • July 01, 2019

    Judge Dismisses Mental Health Counseling Franchise’s Claims Against Former Workers

    LITTLE ROCK, Ark. — A federal judge in Arkansas on June 27 dismissed without prejudice a mental health counseling franchise’s claims that four former employees who filed a False Claims Act suit against it breached the terms of noncompete agreements when leaving the company, finding the court lacked jurisdiction (United States, ex rel. Jacqueline Clemente, et al. v. Lead Teach Mentor LLC, et al., No. 16CV00875, E.D. Ark., 2019 U.S. Dist. LEXIS 107748).

  • June 28, 2019

    Medical Marketing Company Owner Found Guilty Of Paying Kickbacks To Clinics

    TAMPA, Fla. — The owner of a medical marketing company who is already serving 14 years in prison for health care fraud, money laundering and identity theft was found guilty by a federal jury in Florida on June 25 for paying illegal kickbacks to medical clinics as part of a $2.2 million fraud scheme (United States v. David B. Lovelace, No. 14cr512, M.D. Fla.).

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