Mealey's Insurance Fraud

  • October 16, 2018

    Clinic Operators Charged With Running $8.5M Health Care Fraud Scheme

    ATLANTA — The chief operating officer and the CEO of a medical clinic on Oct. 12 were charged in Georgia federal court with individual counts of conspiracy to commit health care fraud for their roles in a fraudulent billing scheme that resulted in private insurers paying $8.5 million for medical services that were never provided (United States of America v. Shailesh Kothari, et al., No. 18cr395, N.D. Ga.).

  • October 15, 2018

    Magistrate Judge Denies Nonparty’s Request To Stay Discovery In Fraud Suit

    DETROIT — A federal magistrate judge in Michigan on Oct. 12 denied a nonparty’s motion to stay discovery and for a protective order in an insurance fraud suit on grounds that the man has not been indicted and that the U.S. Department of Justice’s investigation into his involvement with the scheme does not overlap with State Farm Mutual Automobile Insurance Co.’s lawsuit against a number of physicians and medical clinics (State Farm Mutual Automobile Insurance Co. v. Elite Health Centers Inc., et al., No. 16cv13040, E.D. Mich., 2018 U.S. Dist. LEXIS 175603).

  • October 04, 2018

    Judge Refuses To Vacate Man’s Sentence For Staging Auto Accidents

    NEW YORK — A federal judge in New York on Oct. 3 denied a motion to vacate filed by a man who was sentenced to 10 years in prison for illegally staging automobile accidents and directing individuals to visit corrupt medical clinics, finding that he was unable to show that he received ineffective assistance of counsel before, during and after trial (Maxo Jean v. United States, No. 18 Civ. 2888, S.D. N.Y., 2018 U.S. Dist. LEXIS 171056).

  • October 03, 2018

    Judge Denies Man’s Request To Vacate Sentence For Unemployment Benefits Fraud

    DETROIT — A federal judge in Michigan on Sept. 26 refused to vacate a man’s 44-month prison sentence for fraudulently obtaining unemployment insurance benefits, finding that the court had jurisdiction over the allegations against him because he used the U.S. Postal Service to receive debit cards with the illegally obtained funds (United States of America v. Grady Whitaker Jr., No. 15-20388, E.D. Mich., 2018 U.S. Dist. LEXIS 165093).

  • October 01, 2018

    Judge Denies Man’s Motion For Acquittal, Finds Evidence Shows Involvement in Fires

    SOUTH BEND, Ind. — A federal judge in Indiana on Sept. 27 denied a man’s oral motion for acquittal raised during his trial on four counts of mail fraud, finding that the evidence presented by the government could lead a rational juror to believe that he had a role in starting two fires at his mobile home to deceive his insurance company (United States v. Michael Thomas, No. 18-cr-045 JD, N.D. Ind., 2018 U.S. Dist. LEXIS 166218).

  • October 01, 2018

    11th Circuit Finds No Clear Error In Judge’s Sentencing Of Pharmacy Owner

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Sept. 27 affirmed a pharmacy owner’s 48-month prison sentence after he pleaded guilty to one count of health care fraud, finding that a federal judge in Florida did not commit a clear error when applying the sophisticated means and manager/supervisor enhancements (United States v. Pedro Manuel Mangano, No. 18-10123, 11th Cir., 2018 U.S. App. LEXIS 27553).

  • September 25, 2018

    Litigation Privilege, Witness Immunity Doctrine Do Not Bar Insurer’s Fraud Claims

    LAS VEGAS — A federal judge in Nevada on Sept. 21 ruled that claims brought by Allstate Insurance Co. against two doctors and their practices for allegedly engaging in a scheme to inflate settlement values by creating false bills for patients who were injured as a result of automobile accidents are not barred by the litigation privilege and witness immunity doctrine, finding that the reports used as part of the scheme are not privileged (Allstate Insurance Co., et al. v. Marjorie Belsky, M.D., et al., No. 15cv2265, D. Nev., 2018 U.S. Dist. LEXIS 162318).

  • September 24, 2018

    Chiropractors Cannot Delegate Therapeutic Exercise To Unlicensed Staff, Panel Says

    HARRISBURG, Pa. — A Pennsylvania appeals panel on Sept. 21 affirmed a trial court judge’s ruling that under the Chiropractor Practices Act (CPA), a licensed chiropractor cannot delegate to an unlicensed staff member the supervision of therapeutic exercises for patients covered under the Motor Vehicle Financial Responsibility Law (MVFRL), finding that the testimony of an expert for State Farm Automobile Insurance Co. sufficiently demonstrated that a licensed chiropractor should be involved in the implementation of the exercises (State Farm Automobile Insurance Co. v. Robert J. Cavoto Jr., et al., No. 2593 EDA 2017, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 3523).

  • September 19, 2018

    Judge Trims Former Laboratory Director’s Suit Over Kickbacks, False Billing

    WASHINGTON, D.C. — A federal judge in the District of Columbia on Sept. 12 dismissed in part claims brought by a former laboratory director accusing a company of violating the False Claims Act (FCA) and Anti-Kickback Statute (AKS) when submitting claims to Medicare for lipid screening tests, finding that he did not sufficiently allege that the company could be liable for self-referrals, charging speaker fees for a doctor and nurse practitioner and submitting claims for medically unnecessary tests (United States, ex rel. Chris Riedel v. Boston Heart Diagnostics Corp., No. 12-1423, D. D.C., 2018 U.S. Dist. LEXIS 155113).

  • September 20, 2018

    Judge Sentences Podiatrist To 28 Months In Prison For Health Care Fraud

    ANN ARBOR, Mich. — A podiatrist was sentenced to 28 months in prison by a federal judge in Michigan on Sept. 11 for conducting a $1 million health care fraud scheme that involved submitting bills to Medicare for services that were never provided (United States of America v. Lawrence Young, No. 17cr20240, E.D. Mich.).

  • September 20, 2018

    Ohio Pharmacist Sentenced For Billing Insurers For Prescription Drug Samples

    COLUMBUS, Ohio — A federal judge in Ohio on Sept. 11 sentenced a pharmacist to two years in prison and ordered her to pay $1.1 million in restitution after she pleaded guilty to one count of health care fraud for submitting false claims to Medicare, Ohio Medicaid and the Ohio Bureau of Workers’ Compensation for free samples of prescription drugs she received from manufacturers (United States of America v. Maria Mascio, No. 14cr272, S.D. Ohio).

  • September 19, 2018

    Magistrate Judge Finds Relator’s Request For Metadata From State Farm Premature

    GULFPORT, Miss. — Requests for metadata from State Farm Fire and Casualty Co.’s claims database and for spoliation sanctions sought by a plaintiff in a False Claims Act suit accusing the insurer of submitting false claims for flood damage following Hurricane Katrina were deemed premature by a federal magistrate judge in Mississippi on Sept. 18, after he found that the plaintiff’s request for additional information from the insurer should stem from the claims files it has produced (United States of America, ex rel. Cori Rigsby, et al. v. State Farm Fire and Casualty Co., No. 06cv433-HSO-RHW, S.D. Miss., 2018 U.S. Dist. LEXIS 158641).

  • September 18, 2018

    Farmer Accused Of Filing False Reports With Federal Reinsured Crop Policies

    LEXINGTON, Ky. — The U.S. government filed an indictment on Sept. 6 in a Kentucky federal court against a farmer for submitting false reports regarding federally reinsured crop insurance policies (United States of America v. Christopher G. Hickerson, No. 18-cr-00111, E.D. Ky.).

  • September 11, 2018

    5th Circuit: Judge Did Not Err When Dismissing Relator’s False Billing Claims

    NEW ORLEANS — A federal judge in Texas did not abuse her discretion when granting a motion for voluntary dismissal with prejudice filed by relators in a False Claims Act (FCA) suit accusing the owner of a number of allergy centers of submitting false bills to Medicare and dismissing the government without prejudice, finding that the government and the judge properly consented to the dismissal (United States, ex rel. Michael Vaughn, et al. v. United Biologics LLC, No. 17-20389, 5th Cir., 2018 U.S. App. LEXIS 25450).

  • September 10, 2018

    Connecticut Appeals Panel Vacates Woman’s Conviction For Insurance Fraud

    HARTFORD, Conn. — A Connecticut appeals court panel on Sept. 10 vacated a woman’s conviction for insurance fraud, holding that the same evidence used to support her conviction for two counts of arson could not be used to support the jury’s decision to find her guilty of insurance fraud (Connecticut v. Madeline Griffin, No. AC 40555, Conn. App., 2018 Conn. App. LEXIS 351).

  • September 06, 2018

    Judge Denies Government’s, Executive’s Summary Judgment Motions Over Kickbacks

    CHICAGO — A federal judge in Illinois on Sept. 4 denied motions for summary judgment filed by the federal government and a hospital executive who was found guilty of violating the False Claims Act’s (FCA) Anti-Kickback Statute (AKS), ruling that the defendant did not admit liability as part of his conviction and that the government can seek damages based on payments the defendant received from Medicare and Medicaid (United States v. Edward J. Novak, No. 17 C 4887, N.D. Ill., 2018 U.S. Dist. LEXIS 150234).

  • September 05, 2018

    Montana High Court Vacates Ruling Ordering Fraud Defendant To Pay Fines

    HELENA, Mont. — A panel of the Montana Supreme Court on Sept. 4 reversed a trial court judge’s ruling requiring a woman convicted on two counts of attempted theft by insurance fraud to pay $7,430 in fines, costs and fees, holding that the judge failed to properly consider her ability to pay (Montana v. Dawn Marie Hamilton, No. DA 17-0271, Mont. Sup., 2018 Mont. LEXIS 292).

  • September 04, 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).

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