Mealey's Insurance Fraud

  • August 13, 2020

    California Panel Lacks Jurisdiction Over Relator's Dismissal Of Her Fraud Suit

    LOS ANGELES — A California appeals panel on Aug. 12 ruled that it lacked jurisdiction to review a relator's voluntary dismissal with prejudice of a qui tam action brought under the state's Insurance Fraud Prevention Act (IFPA) against companies accused of submitting fraudulent insurance bills for substance abuse treatment and found that the lower court should vacate the ruling because the woman did not obtain the required court approval before seeking dismissal (California ex rel. Alison Tonti v. Living Rebos LLC, et al., No. B295815, Calif. App., 2nd Dist., 1st Div., 2020 Cal. App. Unpub. LEXIS 5140).

  • August 11, 2020

    Convictions In Operation Backcracker Fraud Scheme Upheld By 8th Circuit

    ST. LOUIS — An Eighth Circuit U.S. Court of Appeals panel on Aug. 10 affirmed the convictions of a chiropractor and two runners who were involved in a scheme known as "Operation Backcracker" that involved the recruitment and submission of insurance claims for victims of automobile accident victims pursuant to the state's No-Fault Act based on the sufficiency of the evidence, but vacated orders regarding the amount of restitution the chiropractor and one of the runners should pay (United States v. Carlos Patricio Luna, et al., Nos. 18-1814, 18-3302, 18-3304, 8th Cir., 2020 U.S. App. LEXIS 25171).

  • August 10, 2020

    Kansas Panel Affirms Dismissal Of Fraud Charges Against Missouri Man

    TOPEKA, Kan.— A Kansas appeals court panel on Aug. 7 affirmed the dismissal of charges for making false statements and violating a fraudulent insurance act statute against a Missouri man, finding that the state lacked jurisdiction to pursue the charges because the defendant's conduct did not occur in Kansas (Kansas v. Ivan Rozell, No. 121,094, Kan. App., 2020 Kan. App. LEXIS 58).

  • August 04, 2020

    Eye Doctor's 17-Year Prison Sentence For Fraud Upheld By 11th Circuit

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on July 31 upheld an ophthalmologist's 17-year prison sentence for operating a Medicare fraud scheme that involved the submission of bills for treating patients who were misdiagnosed with wet age-related macular degeneration (ARMD), holding that the jury was properly instructed on materiality and that the judge overseeing the trial did not make prejudicial evidentiary decisions regarding the admission of a summary charts of Medicare records that were used to show that the prescribing practices of the defendant were markedly different from other similarly situated doctors (United States v. Salomon E. Melgen, No. 18-10991, 11th Cir., 2020 U.S. App. LEXIS 24208).

  • July 31, 2020

    Judge Approves Forfeiture Amount For Fraud Scheme, Rejects Proposed Restitution

    NEW YORK — A federal judge in New York on July 29 ordered a man to forfeit $644,056 for his role in two schemes involved recruiting individuals to stage slip-and-fall accidents and then bring them to attorneys to file lawsuits against businesses and insurance companies, finding that the amount was not excessive and did not violate his rights under the Eighth Amendment to the U.S. Constitution (United States v. Bryan Duncan, No. 18-cr-289, S.D. N.Y., 2020 U.S. Dist. LEXIS 134492).

  • July 27, 2020

    Judge Finds No Compelling Reason To Reduce Fraud Defendant's Sentence

    BOISE, Idaho — A federal judge in Idaho on July 24 denied a motion for a reduction of an insurance fraud defendant's prison sentence, finding that her age, underlying medical conditions and threat of contracting COVID-19 are not compelling reasons for converting the remainder of her sentence to home confinement (United States v. Cherie Renee Dillon, No. 16-cr-037-BLW, D. Idaho, 2020 U.S. Dist. LEXIS 131276).

  • July 23, 2020

    Defendants Appealing Ruling Pending Arbitrations Against GEICO Over Unpaid Claims

    NEW YORK — Three sets of defendants accused of submitting fraudulent bills to the Government Employees Insurance Co. (GEICO) and three of its affiliates on July 7 filed notices of appeal in federal court in New York saying they will ask the Second Circuit U.S. Court of Appeals to review a June 29 ruling that stayed all pending arbitrations brought by the defendants seeking payment and enjoined the defendants from initiating any future arbitrations (Government Employees Insurance Co., et al. v. Yan Moshe, et al., No. 20-cv-1098, E.D. N.Y.).

  • July 23, 2020

    Magistrate Judge Recommends Slightly Reducing Insurer's Fee Award In Billing Suit

    MIAMI — A federal magistrate judge in Florida on July 17 recommended reducing by 25 percent the amount of attorney fees sought by an insurer after it prevailed on a majority of its claims that a clinic and a number of doctors submitted upcoded bills for personal injury protection (PIP) benefits under the state's no-fault insurance law, finding that some of the charges were for duplicative services offered by lead and local counsel (Government Employees Insurance Co., et al. v. Quality Diagnostic Health Care Inc., et al., No. 18-20101, S.D. Fla., 2020 U.S. Dist. LEXIS 128323).

  • July 23, 2020

    8th Circuit Upholds Convictions Of Chiropractor, Runners In No-Fault Scheme

    ST. LOUIS — An Eighth Circuit U.S. Court of Appeals panel on June 26 upheld the convictions and sentences of a chiropractor and two runners who referred patients for treatment to the doctor's office, finding that the evidence presented by the prosecution during their trial supported the jury's findings (United States v. Dana Enoch Kidd Jr., et al., Nos. 18-3327, 18-3328, 18-3558, 8th Cir., 2020 U.S. App. LEXIS 19922).

  • July 21, 2020

    Ruling Denying Fraud Defendant’s Request To Suppress Evidence Affirmed

    TRENTON, N.J. — A New Jersey appeals court panel on July 17 upheld a judge’s ruling that denied an employment insurance benefits fraud defendant’s motion to suppress evidence that was taken from his home after two police officers conducted a weapons search in his home, finding that two laptops and several phones that were used as part of the scheme were found in plain view where weapons could have been located (New Jersey v. Terry E. Dilligard II, No. A-5060-18T4, N.J. Super, App. Div., 2020 N.J. Unpub. LEXIS 1442).

  • July 20, 2020

    Fraud Defendant Denied Compassionate Release Despite Positive COVID-19 Test

    NEW YORK — A federal judge in New York on July 16 denied a motion for compassionate release or a recommendation for a 30-day furlough filed by a man who was sentenced to 144 months in prison for his role in a scheme that involved the sale of stranger-obtained life insurance (STOLI) policies, ruling that while he tested positive for COVID-19, it does not present a compelling reason to release him from prison (United States v. Michael Binday, No. 12 CR 152, S.D. N.Y., 2020 U.S. Dist. LEXIS 125938).

  • July 17, 2020

    11th Circuit Reinstates Medicare Fraud Verdict Against Nursing Home For $85M

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on June 25 vacated in part a federal judge in Florida’s ruling granting a motion for judgment as a matter of law to two skilled nursing facilities (SNFs) in Florida, two entities that provided management services to those facilities and 51 other SNFs in the state and an entity that provided rehabilitation services to those facilities and ruled that they should pay $85 million in damages after finding that a relator in a False Claims Act (FCA) case presented sufficient evidence to show that the companies intentionally submitted fraudulent bills to Medicare (Angela Ruckh v. Salus Rehabilitation LLC, doing business as La Vie Rehab, et al., No. 18-10500, 11th Cir., 2020 U.S. App. LEXIS 19789).

  • July 17, 2020

    Not-For-Profit Insurer Sues Law Firm, Adjusters Over Fraudulent Claims

    TALLAHASSEE, Fla. — A not-for-profit organization created by the Florida Legislature to provide property insurance to residents who are unable to obtain coverage through the open market on June 18 filed a lawsuit in state court accusing a law firm, attorney, a claims adjustment company and remediation contractor of submitting fraudulent claims for coverage that were falsely inflated (Citizens Property Insurance Corp. v. Strems Law Firm PA, et al., No. 2020 CA 001156, Fla. Cir., 2nd Jud. Cir., Leon Co.).

  • 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

    Magistrate Judge Says Insured Made False Statements About Items Damaged By Water

    BUFFALO, N.Y. — A New York federal magistrate judge on June 29 recommended granting a homeowners insurer’s motion for summary judgment in a water damage coverage suit because the evidence clearly shows that the insured made false statements about personal property allegedly damaged by water (Anthony Cimato Jr. v. State Farm Fire & Casualty Co., No. 16-94, W.D. N.Y., 2020 U.S. Dist. LEXIS 115934).

  • 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).