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Mealey's Insurance Fraud

  • September 4, 2018

    6th Circuit Denies Request For En Banc Hearing In Medicare Billing Case

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Aug. 22 denied a senior living center’s request for an en banc rehearing of a ruling reversing dismissal of a former employee’s False Claims Act suit, finding that “the issues raised in the petition were fully considered upon the original submission and decision” (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir.).

  • August 29, 2018

    Insurer’s Summary Judgment Motion In Fire Loss Suit Denied By Judge

    CHICAGO — A jury should determine if alleged misrepresentations made by a man whose home was destroyed by a fire intended to deceive his insurance company, a federal judge in Illinois ruled Aug. 27 in denying the insurer’s motion for summary judgment (State Auto Property & Casualty Insurance Co. Inc. v. Anthony Blair Jr., No. 15 C 8026, N.D. Ill., 2018 U.S. Dist. LEXIS 145335).

  • August 28, 2018

    6th Circuit Affirms Man’s Convictions For Claims Stemming From Fraud Scheme

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Aug. 23 upheld a man’s convictions for health care fraud, naturalization fraud and mail fraud, finding that a federal judge in Michigan did not err when admitting certain testimony from an individual involved in the fraudulent billing scheme and that the evidence presented during the trial was sufficient to support the jury’s decision (United States of America v. Antonio Ramon Martinez-Lopez, No. 17-1860, 6th Cir., 2018 U.S. App. LEXIS 23799).

  • August 27, 2018

    High Court Refuses To Reconsider Denial Of Review Of Accidental Death Claim Suit

    WASHINGTON, D.C. — The U.S. Supreme Court on Aug. 24 stood by its decision to not review the Fifth Circuit U.S. Court of Appeals’ ruling in favor of an insurer in the appellant’s breach of contract lawsuit seeking $750,000 as a beneficiary under an accidental death policy (Abdul Salam Badmus v. Mutual of Omaha Insurance Company [MOOIC], No. 17-7884, U.S. Sup.).

  • August 23, 2018

    DOJ: Physician Who Participated In $30M Fraud Scheme Sentenced

    NEW YORK— A physician who falsely claimed that he was the owner of two clinics that submitted bills to Medicare for services that were either not provided or medically necessary was sentenced Aug. 21 by a federal judge in New York to 366 days in prison and ordered to pay $1.8 million in restitution, the U.S. Department of Justice announced Aug. 22 (United States v. Mustak Y. Vaid, et al., No. 16cr763, S.D. N.Y.).

  • August 20, 2018

    Pennsylvania Appeals Court Tosses Office Manager’s Insurance Fraud Conviction

    HARRISBURG, Pa. — A Pennsylvania Superior Court panel on Aug. 16 vacated a woman’s conviction for insurance fraud, finding that Medicare does not qualify as an insurer for the purposes of the statute she was accused of violating (Pennsylvania v. Rameeza S. Chowdhury, No. 577 MDA 2017, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 2962).

  • August 16, 2018

    Pharmacy Owner Pleads Guilty For Submitting False Bills For Prescriptions

    EAST ST. LOUIS, Ill. — A pharmacist and pharmacy owner on Aug. 14 pleaded guilty in Illinois federal court to two counts of health care fraud for submitting false claims for prescriptions that were not authorized by a physician (United States v. Steven P. Gibson, No. 18-cr-30127, S.D. Ill.).

  • August 15, 2018

    Judge Did Not Err When Sentencing Man For Identity Theft, 6th Circuit Says

    CINCINNATI — A federal judge in Michigan did not err when sentencing a man to 72 months in prison after he pleaded guilty to aggravated identity theft as part of a scheme to fraudulently obtain unemployment insurance benefits, a Sixth Circuit U.S. Court of Appeals panel ruled Aug. 13, finding that the judge did not err when denying the defendant’s motion to withdraw the plea and properly calculated the man’s sentence (United States of America v. Edward C. Galka, No. 17-2216, 6th Cir., 2018 U.S. App. LEXIS 22491).

  • August 14, 2018

    Judge Dismisses Majority Of Doctor’s Counterclaims Against Insurer Over Coverage

    CONCORD, N.H. — A federal judge in New Hampshire on Aug. 13 dismissed six of an ophthalmologist’s eight counterclaims against an insurance company seeking to rescind a policy issued to him and his practice, finding that he could not pursue claims under Massachusetts law because New Hampshire law applies to the suit and because the insurer’s complaint cannot form the basis for counterclaims of libel, defamation and false light (General Star Indemnity Co. v. Adam P. Beck M.D., et al., No. 18-cv-108-JD, D. N.H., 2018 U.S. Dist. LEXIS 136019).

  • August 14, 2018

    North Carolina Appeals Panel Vacates Man’s Conviction For Insurance Fraud

    RALEIGH, N.C. — A North Carolina appeals panel on Aug. 7 vacated a man’s conviction for insurance fraud after finding that the state failed to present sufficient evidence to show that he made a fraudulent statement to his insurance company about the cause of a fire that destroyed a diner he helped operate (North Carolina v. Eric Ferrer, No. COA17-655, N.C. App., 2018 N.C. App. LEXIS 760).

  • August 13, 2018

    Woman Withdraws Not Guilty Plea To Health Care Fraud

    BENTON, Ill. — An Illinois woman on Aug. 10 pleaded guilty to one felony count of health care fraud in Illinois federal court after withdrawing her earlier plea of not guilty (United States of America v. Betsy Gutowski, No. 17cr40046, S.D. Ill.).

  • August 8, 2018

    Judge Vacates Entry Of Default Against Doctor, Clinic Accused Of Fraud

    CAMDEN, N.J. — A federal judge in New Jersey on Aug. 6 vacated an entry of default against a doctor and a clinic accused of submitting fraudulent bills to the Government Employees Insurance Co. (GEICO), finding that the defendants raised meritorious defenses to the insurer’s allegations and that the company’s complaint contained “shotgun pleadings” (Government Employees Insurance Co. v. Pennsauken Spine & Rehab PC, et al., No. 17-11727, D. N.J., 2018 U.S. Dist. LEXIS 131529).

  • August 6, 2018

    Appeals Panel Upholds Woman’s Insurance Fraud Conviction, Tosses Failure To Appear

    SACRAMENTO, Calif. — A California appeals panel on Aug. 1 affirmed a woman’s conviction on three counts of insurance fraud, holding that evidence presented during the trial sufficiently showed that she was not a passenger in a vehicle when it was struck by another vehicle (People of the State of California v. Deborah Carter, No. C083541, C084717, Calif. App., 3rd Dist., 2018 Cal. App. Unpub. LEXIS 5269).

  • August 2, 2018

    Home Care Services Company, Operators Ordered To Pay $2.9M Over False Billing

    RALEIGH, N.C. — A federal judge in North Carolina on July 30 ordered a home health care services company and its operators to pay $2.9 million for violating the federal and North Carolina false claims acts when submitting fraudulent bills for services that were provided in violation of Medicare policies or not provided at all and falsifying documents to conceal the fraud (United States, et al. v. Compassionate Home Care Services Inc., et al., No. 14-CV-113-D, E.D. N.C.).

  • August 1, 2018

    Federal Jury Convicts Sleep Study Clinic Owner For Health Care Fraud

    ALEXANDRIA, Va.— A jury in Virginia federal court on July 30 convicted the former owner of a sleep study clinic on one count of conspiracy to commit health care fraud and wire fraud, one count of conspiracy to defraud the United States, one count of filing a false tax return and seven counts of health care fraud (United States of America v. Young Yi, et al., No. 17cr224, E.D. Va.)

  • July 31, 2018

    Judge Adjusts Man’s Sentence For Unemployment Benefits Fraud Charges

    MILWAUKEE — A federal judge in Wisconsin on July 27 amended a man’s sentenced for wire fraud and aggravated identity theft as part of a scheme to fraudulently obtain unemployment insurance benefits, finding that his appellate counsel acted deficiently when failing to argue that his sentence should be adjusted to reflect for time he served in state prison (Calvin V. Sanders v. United States of America, No. 18-cv-919, E.D. Wis., 2018 U.S. Dist. LEXIS 125657).

  • July 26, 2018

    Evidence Supported Restitution Amount Ordered In Disability Fraud Suit, Panel Says

    SACRAMENTO, Calif. — A trial court judge did not abuse his discretion when ordering a man to repay $5,502 to his employer for temporary disability benefits he unlawfully received, a California appeals court panel ruled July 24, finding that the evidence presented by the state sufficiently supported the amount (People of the State of California v. Michael William Williams, No. C086000, Calif. App., 3rd Dist., 2018 Cal. App. Unpub. LEXIS 5057).

  • July 23, 2018

    Magistrate Recommends Accepting Guilty Pleas For Health Care Fraud

    TAMPA, Fla. — A federal magistrate judge in Florida on July 20 recommended accepting a woman’s guilty pleas to two counts of health care fraud, finding that she is knowledgeable about the offenses for which she is charged (United States of America v. Lisa McLaren Janick, No. 17cr502, M.D. Fla.).

  • July 19, 2018

    6th Circuit Allows Amicus Briefs Seeking Rehearing Of Medicare Billing Case

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on July 16 granted requests from the Washington Legal Foundation (WLF) and National Association for Home Care & Hospice Inc. (NAHCH) to submit amicus curiae briefs in support of a nursing home facility’s request for an en banc hearing as to whether a former worker sufficiently alleged that the company made material misrepresentations under the False Claims Act (FCA) when failing to timely submit physician certification to support treatment provided to patients (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir.).

  • July 19, 2018

    Ambulance Company To Pay $16,776 For Submitting False Claims

    BANGOR, Maine — An ambulance company has agreed to pay the federal government and state of Maine $16,776.74 to resolve claims that it submitted false bills to Medicare and Maine’s Medicaid program, MaineCare, from January 2015 through April 2016 to pay the salary of an employee who had previously been excluded from participating in federal and state health care programs, according to a notice of settlement filed July 17 in Maine federal court (United States v. County Ambulance Service Inc., No. 18-cv-280, D. Maine).