Mealey's Insurance Fraud

  • June 18, 2018

    11th Circuit: Evidence Supported Convictions For Arson Scheme

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on June 14 affirmed rulings by a federal judge in Georgia denying two defendants’ motions for acquittal, holding that the evidence presented by the government sufficiently showed that they conspired and committed mail fraud as part of a scheme to submit fraudulent insurance claims after setting homes on fire (United States v. Shirley Denise Burk, et al., No. 16-14248, 11th Cir., 2018 U.S. App. LEXIS  15979).

  • June 13, 2018

    Panel: Trial Court Must Recalculate Restitution For Insurer’s Investigation

    RIVERSIDE, Calif. — An appeals court panel in California on May 31 vacated a trial court judge’s ruling ordering a woman who pleaded guilty to one count of making a false statement in support of an insurance claim to pay $1,042.17 in restitution to an insurance company, finding that the company did not take into account the costs it incurred as a result of its investigation of the defendant’s claim (People of California v. Alyce J. Williams, No. D072783, Calif. App., 4th Dist., 1st Div., 2018 Cal. App. Unpub. LEXIS 3728).

  • June 13, 2018

    Opioid Addiction Treatment Center Owner Indicted For Insurance Fraud

    PITTSBURGH — The owner of an opioid addiction treatment center was indicted in Pennsylvania federal court June 5 on charges of health care fraud, conspiracy to unlawfully distribute a controlled substance, and aiding and abetting the unlawful distribution of a controlled substance for allegedly dispensing buprenorphine, a drug used to treat addiction, and submitting fraudulent claims to Medicare and Medicaid for the drug (United States v. Jennifer Hess, No. 18cr142, W.D. Pa.).

  • June 13, 2018

    Divided 6th Circuit Reverses Dismissal Of Suit Over Senior Center’s Billing

    CINCINNATI — A woman’s False Claims Act (FCA) lawsuit accusing a senior living center of failing to submit to Medicare certifications supporting the need for medical services for patients was reinstated June 11 by a 2-1 Sixth Circuit U.S. Court of Appeals panel, after it found that the woman’s allegations satisfied the act’s requirements for materiality and scienter (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir., 2018 U.S. App. LEXIS 15617).

  • June 13, 2018

    Farmers Indicted On False Claims For Reinsured Crop Insurance Program

    LEXINGTON, Ky. — Farmers defrauded the United States through the filing of false insurance claims reimbursed by the U.S. Department of Agriculture (USDA) and by making false statements and reports in connection with the federally reinsured crop insurance program, the government alleges in a June 6 indictment filed in a Kentucky federal court (United States v. Bradley Price, et al., No. 18-cr-60, E.D. Ky.).

  • June 11, 2018

    Judge Denies General Practitioner’s Motion To Vacate Fraud Conviction

    SAN JOSE, Calif. — A federal judge in California on June 8 denied a general practitioner’s motion for acquittal on charges of health care fraud, finding that the spreadsheets and explanation of benefit (EOB) documents presented by the government constituted sufficient evidence showing that the doctor submitted fraudulent claims to insurance companies (United States v. Vilasini Ganesh, et al., No. 16cr00211, N.D. Calif., 2018 U.S. Dist. LEXIS 97028).

  • June 06, 2018

    Panel: Judge Erred When Modifying Plea Agreement For Lawyer Accused Of Fraud

    TRENTON, N.J.  — A New Jersey appeals court panel on June 5 reversed a judge’s decision to grant a request for pretrial intervention (PTI) from an attorney accused of insurance fraud, finding that the judge erred when vacating a different judge’s previous ruling denying the request (New Jersey v. Neal Pomper, No. A-3969-16T1, N.J. Super., App. Div., 2018 N.J. Super. Unpub. 1305).

  • June 05, 2018

    Pennsylvania Appeals Panel Affirms Woman’s Conviction For Arson, Insurance Fraud

    PITTSBURGH — A Pennsylvania appeals court panel on May 31 affirmed a woman’s conviction and 20- to 40-month sentence for insurance fraud and arson, finding that she received effective assistance of counsel (Pennsylvania v. Julia Ann Calipo, No. 1929 WDA 2016, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 1861).

  • June 04, 2018

    Judge Stays Coverage Suit Pending Insurer’s Liquidation Proceedings

    CHICAGO — An Illinois federal judge on June 1 stayed a coverage dispute between an insolvent Missouri insurer and an insured doctor regarding coverage provided under a professional liability insurance policy pending the duration of the liquidation proceedings (Galen Insurance Co. v. Vittorio Guerriero, M.D., et al., No. 15-06993, N.D. Ill., 2018 U.S. Dist. LEXIS 91393).

  • May 30, 2018

    Insurers Sufficiently Pleaded Fraud, RICO Claims Stemming From Scheme, Judge Rules

    MINNEAPOLIS — A federal judge in Minnesota on May 25 refused to dismiss a lawsuit brought by seven insurance companies accusing the owners of a number of chiropractic clinics of scheming to submit more than $1.8 million in fraudulent bills, finding that the companies’ fraud allegations satisfied the requirements of Federal Rule of Civil Procedure 9(b) and that the plaintiffs sufficiently stated claims under the Racketeer Influenced and Corrupt Organizations Act (Illinois Farmers Insurance Co., et al. v. Lake Street Chiropractic Clinic P.A., et al., No. 17-5090, D. Minn., 2018 U.S. Dist. LEXIS 87767).

  • May 30, 2018

    Panel Affirms Finding That Insurance Fraud Defendant’s Counsel Was Effective

    PHILADELPHIA — A Pennsylvania appeals panel on May 28 affirmed a trial court’s ruling denying a man’s request for relief under the Post Conviction Relief Act (PCRA) following his convictions for insurance fraud, corrupt organizations and identity theft, holding that the lower court judge did not err when finding that the man received effective assistance of counsel (Pennsylvania v. Michael David Ruth, No. 411 EDA 2017, Pa. Super., 2018 Pa. Super. LEXIS 1737).

  • May 25, 2018

    Surgery Center’s Consumer Fraud Counterclaim Against Insurers Dismissed By Judge

    CHICAGO — A surgery center failed to sufficiently state a claim against two insurance companies for violating the Illinois Consumer Fraud Act (ICFA), a federal judge in Illinois ruled May 24, holding that the insurers’ alleged misrepresentations to the center about whether its procedures were covered did not harm the patient population (Connecticut General Life Insurance Co., et al. v. Southwest Surgery Center LLC, No. 14-cv-8777, N.D. Ill., 2018 U.S. Dist. LEXIS 87551).

  • May 23, 2018

    2nd Circuit Upholds Sentence For ‘Brazen’ Employment Insurance Fraud Scheme

    NEW YORK — A Second Circuit U.S. Court of Appeals panel on May 21 upheld a federal judge in New York’s decision to sentence a man who pleaded guilty to fraudulently procuring $13,961 in unemployment insurance benefits from the New York Department of Labor while working as a correctional officer to six months in prison, holding that the judge sufficiently explained that the sentence was based on the brazen nature of the offense (United States v. Andrew Kessler, No. 17-2317-cr, 2nd Cir., 2018 U.S. App. LEXIS 13088).

  • May 21, 2018

    Judge Quashes Subpoenas Seeking Records Of All Of Doctor’s Toenail Avulsions

    NASHVILLE, Tenn. — A federal judge in Tennessee on May 18 quashed two subpoenas served on rehabilitation centers where a doctor who was found guilty of four counts of health care fraud performed toenail avulsions, finding that the requests were unduly burdensome and that they were not necessarily relevant for the calculation of the amount of loss incurred by Medicare and other insurers (United States v. John J. Cauthon, No. 15-cr-00172, M.D. Tenn., 2018 U.S. Dist. LEXIS 84104).

  • May 17, 2018

    California Panel Affirms Employment Restrictions For Insurance Fraud Defendant

    RIVERSIDE, Calif. — A California appeals court panel on May 10 found that a trial court judge did not err when finding that a man convicted of insurance fraud should not be allowed to hold a job in which he is required to use or control a bank account, finding that the probation restriction is intended to deter the defendant from future criminality (California v. Mario Tedoro Rios, No. D072430, Calif. App., 4th Dist., 1st Div., 2018 Calif. App. Unpub. LEXIS 3180).

  • May 15, 2018

    State Farm’s Fraud Suit Not Subject To Abstention, Preemption, Judge Rules

    FLINT, Mich. — State Farm Mutual Automobile Insurance Co.’s lawsuit accusing defendants of engaging in a scheme to submit fraudulent bills under its insureds’ no-fault insurance benefits coverage is not subject to abstention or preemption, a federal judge in Michigan ruled May 14 in denying the defendants’ motion to dismiss (State Farm Mutual Automobile Insurance Co. v. Vital Community Care PC, et al., No. 17-11721, E.D. Mich., 2018 U.S. Dist. LEXIS 80361).

  • May 14, 2018

    Judge Adopts Recommendation To Deny Fraud Defendant’s Motion To Vacate Sentence

    DALLAS — A federal judge in Texas on May 1 adopted a magistrate judge’s report and recommendation to deny a woman’s motion to vacate or set aside her 57-month prison sentence for health care fraud, holding that she received effective assistance of counsel and that the sentencing judge did not err when finding that her scheme resulted in more than $1.6 million in losses to Medicare (Brenda Ward v. United States, No. 16-cv-3128, N.D. Texas).

  • May 14, 2018

    Former Radiologist Pleads Guilty To Health Care Fraud, Prescribing Vicodin

    PITTSBURGH — A former radiologist at the University of Pittsburgh Medical Center (UPMC) on May 3 pleaded guilty to charges of health care fraud and unlawfully prescribing Vicodin, according to documents filed in Pennsylvania federal court (United States v. Marios Papachristou, No. 18-cr-0084, W.D. Pa.).

  • May 14, 2018

    Owner Of Mental Health Services Clinic Sentenced To 6 Years For Insurance Fraud

    HARRISBURG, Pa.  — A federal judge in Pennsylvania on May 9 sentenced the owner of a mental health services clinic to six years in prison and ordered her to pay $151,122.17 in restitution for billing Medicare for psychiatric services provided to the elderly and adolescents by unlicensed and untrained individuals (United States of America v. Joan Cicchiello, No. 15-cr-223, M.D. Pa.).

  • May 09, 2018

    California Panel Vacates Ruling Finding Officer’s Wife Guilty Of Insurance Fraud

    SAN DIEGO — A California appeals panel on May 8 vacated a woman’s conviction for her alleged role in her husband’s filing of a fraudulent insurance claim for the theft of his car, finding that the evidence did not sufficiently establish that she aided or abetted the scheme (California v. Robert Patrick Mejia, et al., No. D073113, Calif. App., 4th Dist., 1st Div., 2018 Cal. App. Unpub. LEXIS 3121).

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