Mealey's Insurance Fraud

  • March 11, 2019

    Testimony On Other Staged Car Accidents Was Admissible, 2nd Circuit Says

    NEW YORK — A Second Circuit U.S. Court of Appeals panel ruled March 6 that a federal judge in Connecticut did not err when allowing a co-conspirator’s testimony about two defendants’ involvement with 50 staged automobile accidents that served as the basis for the submission of fraudulent insurance claims, finding that the testimony was not outside the scope of the charges against the defendants (United States v. Frandy Dugue, et al., Nos. 17-3315, 17-3578, 2nd Cir., 2019 U.S. App. LEXIS 6907).

  • March 11, 2019

    Former Auditor’s False Claims Act Suit Over Referrals Dismissed By Judge

    FORT MYERS, Fla. — A federal judge in Florida on March 6 dismissed without prejudice a former internal auditor’s False Claims Act (FCA) lawsuit accusing a public health care facilities operator of engaging in a scheme of obtaining reimbursements from Medicare and Medicaid stemming from illegal referrals among doctors, finding that the allegations lacked the required amount of specificity and particularity (United States, ex rel. Angela D’Anna v. Lee Memorial Health System, No. 14-cv-437, M.D. Fla., 2019 U.S. Dist. LEXIS 35783).

  • March 06, 2019

    Judge Refuses Request To Sever Claims For Health Care Fraud, Drug Distribution

    BUFFALO, N.Y.— A federal judge in New York on Feb. 27 denied a request from a doctor charged with health care fraud and illegal distribution of controlled substances to sever the claims for separate trials, finding that he would not be prejudiced if the claims were tried simultaneously (United States v. Eugene Gosy, No. 16-CR-46, W.D. N.Y., 2019 U.S. Dist. LEXIS 31404).

  • March 04, 2019

    Judge Refuses To Dismiss GEICO’s Claims Against Owner Of Sham Business

    NEW YORK — The Government Employees Insurance Co. (GEICO) sufficiently alleged claims against a woman accused of owning sham businesses that were involved in a scheme initiated by acupuncture clinics that allegedly billed the insurer for millions of dollars' worth of services that they were not eligible to receive under New York’s Comprehensive Motor Vehicle Insurance Reparations Act (No-Fault Law), a federal judge in New York ruled March 1 (Government Employees Insurance Co. v. Mayzenberg, et al., No. 17-CV-2802, E.D. N.Y., 2019 U.S. Dist. LEXIS 33199).

  • March 04, 2019

    4th Circuit Finds No Error In Admitting Hearsay Statements During Fraud Trial

    RICHMOND, Va. — A Fourth Circuit U.S. Court of Appeals panel on Feb. 27 affirmed a federal judge in Virginia’s decision to admit hearsay statements provided by a deceased woman’s mother and an insurance investigator during a trial against a woman who was later convicted for changing the beneficiary information on her friend’s life insurance policy, finding that the judge properly applied the residual hearsay exception (United States v. Semyya Cunningham, No. 18-4664, 4th Cir., 2019 U.S. App. LEXIS 5880).

  • February 25, 2019

    Senior Center Says High Court Must Review Pleading Standards In Billing Suit

    WASHINGTON, D.C. — A senior living facility accused of routinely submitting fraudulent bills to Medicare on Feb. 20 told the U.S. Supreme Court that the high court must decide what requirements are necessary for successfully pleading scienter and materiality under the False Claims Act (FCA) because the courts of appeals are split on the issues (Brookdale Senior Living Communities Inc. v. United States, ex rel. Marjorie Prather, No. 18-699, U.S. Sup.).

  • February 22, 2019

    California Panel Vacates Woman’s Conviction For Workers’ Compensation Fraud

    LOS ANGELES — A California appeals panel on Feb. 13 vacated a portion of a woman’s conviction for insurance fraud, finding that there was insufficient evidence to show that she submitted a false claim for workers’ compensation benefits (California v. Sharon L. Davis, No. B286377, Calif. App., 2nd Dist., 8th Div., 2019 Cal. App. Unpub. LEXIS 1061)

  • February 20, 2019

    Judge Overrules Doctors’ Objections To Ruling Refusing To Quash Subpoenas

    LAS VEGAS — A federal judge in Nevada on Feb. 14 overruled objections by two doctors accused of submitting bills to Allstate Insurance Co. and its affiliates for medical services provided to victims of automobile accidents that were not provided or medically unnecessary to a magistrate judge’s ruling denying their motion to quash subpoenas seeking financial records, finding that the requested information is relevant and that the subpoenas cannot be narrowed (Allstate Insurance Co., et al. v. Marjorie Belsky, M.D., et al., No. 15-cv-2265, D. Nev., 2019 U.S. Dist. LEXIS 24986).

  • February 14, 2019

    Transportation Company Owner Pleads Guilty To Health Care Fraud, Kickback Charges

    SYRACUSE, N.Y. — The owner of a medical transportation company pleaded guilty in New York federal court on Feb. 12 to charges of conspiracy to commit health care fraud and conspiracy to pay bribes and kickbacks to Medicare beneficiaries after his company obtained nearly $2.4 million from the New York Department of Health (DOH) after submitting fraudulent bills to the program from 2014 until 2018 (United States v. Arshad Nazir, No. 19cr22, N.D. N.Y.).

  • February 13, 2019

    2 South Carolina Women Plead Guilty For Providing False Statements To Medicare

    COLUMBIA, S.C. — Two women who were executives of a company that provided services to children and adults with autism on Feb. 5 pleaded guilty in South Carolina federal court to charges of fraudulently billing Medicare and encouraging employees to bill the program for time that was not spent providing services to patients (United States v. Angela B. Keith, et al., No. 19cr91, D. S.C.).

  • February 12, 2019

    Magistrate Judge Recommends Accepting Guilty Plea For Obstructing Medicare Audit

    TAMPA, Fla. — A federal magistrate judge in Florida on Feb. 7 recommended accepting a psychologist’s guilty plea for one count of obstructing a Medicare audit in 2012, finding that the defendant was knowledgeable of the allegations against him and that he entered the plea willingly (United States v. Charles Gerardi, No. 18cr289, M.D. Fla.).

  • February 11, 2019

    Judge Finds Man Unjustly Enriched By Insurer’s Erroneous Payment

    BOSTON — A federal judge in Massachusetts on Feb. 7 ordered a man to pay $217,000 to Metropolitan Life Insurance Co. after finding that he was unjustly enriched when the insurer accidentally overpaid him for a life insurance policy held by his now-deceased father (Metropolitan Life Insurance Co. v. Eric A. Beard, No. 16-11782-PBS, D. Mass., 2019 U.S. Dist. LEXIS 20053).

  • February 07, 2019

    Magistrate Judge Finds Insurer Sufficiently Alleged Fraud Over Water Damage

    TUSCALOOSA, Ala. — An insurance company’s complaint contains sufficient allegations to support its claim that a business policy holder fraudulently inflated losses it suffered as a result of water damage to the building it rented, a federal magistrate judge in Alabama ruled Feb. 5 in denying the insured’s motion to dismiss (Cincinnati Insurance Co. v. Atlas Healthcare LLC, No. 17-cv-1310, N.D. Ala., 2019 U.S. Dist. LEXIS 17875).

  • February 06, 2019

    Compounding Pharmacy To Pay $1.7M To Resolve False Claims Act Suit

    PHILADELPHIA — A Pennsylvania-based compounding pharmacy on Feb. 4 entered into an agreement in Pennsylvania federal court with the federal government in which it agreed to pay $1.7 million to resolve allegations in a suit brought by a former employee under the qui tam provision of the False Claims Act in which she claimed that the company submitted fraudulent bills to Medicare and Medicaid for its drug Proplete (United States et al. ex rel. Jean Brasher v. Pentec Health, Inc., No. 13-cv-05745, E.D. Pa.).

  • February 05, 2019

    GEICO Accuses ‘Transient Medical Services Providers’ Of Fraudulent Billing

    NEW YORK — The Government Employees Insurance Co. (GEICO) and its subsidiaries on Feb. 4 filed a lawsuit in New York federal court accusing two doctors and their practices of submitting $1.9 million in claims for services to patients who were purportedly injured in automobile accidents that were medically unnecessary or not provided (Government Employees Insurance Co., et al. v. Marina Galea, M.D., et al., No. 19-cv-0663, E.D. N.Y.).

  • February 05, 2019

    California Appeals Panel Finds No Error In Juror’s Excuse From Fraud Case

    SAN FRANCISCO — A juror was properly excused from an insurance fraud trial for failing to deliberate, a California appeals panel ruled Jan. 31 in upholding a man’s conviction of two counts of insurance fraud, finding that the presiding judge did not err when relying on the notes and testimony of another juror (People of the State of California v. Adam Scott Ravaglia, No. A149657, Calif. App., 1st Dist., 3rd Div., 2019 Calif. Unpub. LEXIS 798).

  • February 04, 2019

    Man’s Conviction For Conspiring To Commit Arson For Insurance Proceeds Upheld

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Feb. 1 affirmed a federal judge in Georgia’s denial of a man’s motion for acquittal after he was found guilty of conspiracy to commit arson, holding that the government presented sufficient evidence to show that he engaged in a pattern with his co-defendants of purchasing properties, obtaining insurance and then setting the houses on fire (United States v. Elbert Walker Jr., No. 16-13642, 11th Cir., 2019 U.S. App. LEXIS 3328).

  • January 30, 2019

    Judge Orders Clinics, Claims Facility To Refine Records Request, Objections

    FLINT, Mich. — A federal judge in Michigan on Jan. 29 denied in part a motion to compel filed by the Michigan Automobile Insurance Placement Facility (MAIPF) seeking records from a number of chiropractic clinics and employees accused of engaging in a scheme intended to fraudulently generate bills for unnecessary medical services provided to individuals submitted claims for no-fault personal injury protection benefits, ordering the facility to refine its records requests and the defendants to provide more details for their objections (Michigan Automobile Insurance Placement Facility v. New Grace Rehabilitation Center PLLC, et al., No. 17-11007, E.D. Mich., 2019 U.S. Dist. LEXIS 13511).

  • January 30, 2019

    Drug-Testing Laboratory Did Not Fraudulently Bill Insurer, Judge Rules

    LOS ANGELES — A trial court judge in California on Jan. 25 awarded summary judgment to a laboratory accused by a woman of violating the California Insurance Fraud Prevention Act (CIFPA) for fraudulently billing her insurer for urine drug tests that were not medically unnecessary, holding that the woman failed to present any evidence showing that the defendant engaged in an unlawful relationship with health care providers to recruit patients and that it intended to defraud insurers (California, ex rel. Alison Tonti v. Living Rebos LLC, et al., No. BC674091, Calif. Super., Los Angeles Co.).

  • January 28, 2019

    Magistrate Judge: Only Doctor Liable For Submitting Claims For Barred Procedures

    NEW YORK — A federal magistrate judge in New York on Jan. 24 recommended granting in part a motion for default judgment filed by the Government Employees Insurance Co. (GEICO) and its affiliates against a doctor accused of breaching a settlement agreement that prevented him from submitting claims for electromyography (EMG) and nerve conduction velocity (NCV) testing that he did not perform, holding that only the doctor, not a corporation he formed after the entry of the settlement agreement, should be liable for repaying the insurer the amount it paid for the claims (Government Employees Insurance Co. v. Michael Alleyne, et al., No. 17-CV-4778, E.D. N.Y., 2019 U.S. Dist. LEXIS 12604).

Can't find the article you're looking for? Click here to search the Mealey's Insurance Fraud archive.