Mealey's Insurance Fraud

  • August 28, 2019

    Judge Overrules Nonparty’s Objections To State Farm’s Document Request

    DETROIT — A federal judge in Michigan on Aug. 26 overruled a nonparty’s objections to a magistrate judge’s ruling ordering him to produce documents about his relationship with clinics and doctors accused of submitting fraudulent bills to State Farm Mutual Automobile Insurance Co., finding that the man’s arguments “did not carry the day” (State Farm Mutual Automobile Insurance Company v. Elite Health Centers Inc., et al., No. 16cv13040, E.D. Mich., 2019 U.S. Dist. LEXIS 144205).

  • August 28, 2019

    Cardiologist Convicted Of Defrauding Government Seeks Review Of Experts’ Allowance

    WASHINGTON, D.C. — A federal trial court’s improper admission of several doctors’ expert opinions in a health care fraud case against an Ohio cardiologist warrants review by the U.S. Supreme Court, the heart doctor — who was convicted by a jury — tells the high court in an Aug. 14 petition for a writ of certiorari (Harold Persaud v United States, No. 19-216, U.S. Sup., 2019 U.S. S. Ct. Briefs LEXIS 3330).

  • August 27, 2019

    Clinics’, Doctor’s Objections To Denial Of Request To Disqualify Firms Overruled

    DETROIT — A federal judge in Michigan on Aug. 26 overruled objections filed by doctors and clinics accused of submitting fraudulent bills to State Farm Mutual Automobile Insurance Co. for personal injury protection (PIP) benefits to a magistrate judge’s ruling denying their request to move to disqualify two firms representing the insurer, holding that nothing in the magistrate judge’s ruling was “clearly erroneous or contrary to law” (State Farm Mutual Automobile Insurance Company v. Elite Health Centers Inc., et al., No. 16cv13040, E.D. Mich., 2019 U.S. Dist. LEXIS 144199).

  • August 27, 2019

    Judge:  Fraud Defendant’s Ex-Wife’s Statements Can Be Disclosed

    DETROIT — An insurance fraud defendant’s objections to a magistrate judge’s ruling allowing the disclosure of statements he made to his now ex-wife that were contained in an affidavit she submitted were overruled by a federal judge in Michigan on Aug. 26, after the judge found that the statements were not privileged (State Farm Mutual Automobile Insurance Company v. Elite Health Centers Inc., et al., No. 16cv13040, E.D. Mich., 2019 U.S. Dist. LEXIS 144195).

  • August 21, 2019

    Man Sentenced For Fraudulent Billing For Durable Medical Equipment

    LOS ANGELES — A federal judge in California on Aug. 19 sentenced a man to 46 months in prison and ordered him to pay more than $1 million in restitution after he pleaded guilty to paying kickbacks for prescriptions for durable medical equipment (DME) that were not medically necessary (United States v. Ayodeji T. Fatunmbi, et al., No. 13cr, C.D. Calif.).

  • August 20, 2019

    Judge Explains Dismissal Of Breach Of Implied Covenant Claim Against Insurer

    MINNEAPOLIS — A federal judge in Minnesota on Aug. 16 explained his ruling dismissing a man’s claim for breach of the implied warranty of good faith and fair dealing against his insurer, stating that he believes the state addressed the issue of unreasonable handling of claims in insurance contracts in its legislature and that a state appeals panel’s ruling recognizing the cause of action was not persuasive (Selective Insurance Company of South Carolina v. Amit Sela, No. 16-cv-4077, D. Minn., 2019 U.S. Dist. LEXIS 138666).

  • August 20, 2019

    Man’s Community Service Sentence For Fraud Vacated By 2nd Circuit Panel

    NEW YORK — A Second Circuit U.S. Circuit Court of Appeals panel on Aug. 19 vacated a federal judge in New York’s ruling requiring a man who pleaded guilty to insurance fraud and bank fraud to perform more than 300 hours of community service per year over the course of his supervised release, holding that the sentence did not comply with a policy statement issued by the Sentencing Commission (United States v. Nikos Parkins, No. 18-1019, 2nd Cir., 2019 U.S. App. LEXIS 24563).

  • August 15, 2019

    5th Circuit Affirms Reliability Of Experts In $300M Case Over FHA Loans

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on July 8 affirmed the allowance of expert testimony in a mortgage fraud case that resulted in a nearly $300 million judgment against a businessman and his companies after finding that the trial judge properly vetted the experts’ opinions and sufficiently explained his rationale for doing so (United States v. Jim C. Hodge, et al., No. 17-20720, 5th Cir., 2019 U.S. App. LEXIS 23715).

  • August 15, 2019

    Man Pleads Guilty For Submitting False Claims For Prescription Medications

    ATLANTA — A man pleaded guilty on Aug. 9 in Georgia federal court to one count of health care fraud for obtaining $300,000 from the Colorado Public Employees Retirement Association (COPERA) by submitting false claims for reimbursement for prescription medications he did not receive or that were more expensive than the medications he was receiving (United States v. Michael Bang, No. 18cr433, N.D. Ga.).

  • August 13, 2019

    Judge Transfers GEICO’s Suit Over Fraudulent Billing To New Jersey

    NEW YORK — A federal judge in New York on Aug. 8 transferred to New Jersey federal court a lawsuit brought by the Government Employees Insurance Co. (GEICO) against a New Jersey-based ambulatory care center, its management company and three doctors over a fraudulent billing scheme for personal injury protection (PIP) benefits, ruling that New Jersey is a more appropriate forum because the care center submitted the bills to the insurer (Government Employees Insurance Company v. Daniel J. Yoo, M.D., et al., No. 18-cv-5735, E.D. N.Y., 2019 U.S. Dist. LEXIS 134026).

  • August 12, 2019

    5th Circuit Upholds Denial Of Fraud Defendant’s Requested Jury Instruction

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Aug. 8 upheld a federal judge in Texas’ ruling denying an insurance fraud defendant’s request for a good faith jury instruction, holding that the defendant failed to show that the omission of a jury instruction impaired his good faith defense (United States v. David Roy Williams, No. 18-11184, 5th Cir., 2019 U.S. App. LEXIS 23848).

  • August 07, 2019

    Judge Finds Insurance Agency May Have Breached Duty To Procure Sufficient Policy

    NEW ORLEANS — A federal judge in Louisiana on Aug. 6 denied an insurance agency’s motion for summary judgment on claims brought by a couple claiming that it should indemnify them for damages from a fire that destroyed their home, finding that genuine disputes exist as to whether the agency breached its duty to procure a policy that would have covered the home (GeoVera Specialty Insurance Co. v. Mariette Joachin, et al., No. 18-7577, E.D. La., 2019 U.S. Dist. LEXIS 131033).

  • August 05, 2019

    Panel Affirms Judgment For Insurer In Fire Case After Upholding Expert Rulings

    ST. LOUIS — Physical testing at the scene of a fire that destroyed a building was not required for an insurer’s expert witnesses to opine on when the blaze started, the Eighth Circuit U.S. Court of appeals ruled Aug. 1 in affirming denial of a new trial for a Missouri couple (Allstate Indemnity Company v. Joseph Dixon, et al., No. 18-1948, 8th Cir., 2019 U.S. App. LEXIS 23021).

  • August 02, 2019

    Rulings Quashing Bill Of Information In Insurance Fraud Suit Overturned On Appeal

    NEW ORLEANS — A Louisiana appeals panel on July 31 vacated a ruling quashing a bill of information charging four individuals with insurance fraud, finding that the allegations in the document were not deficient and that the court had jurisdiction over the suit (State of Louisiana v. Colleen Brown, et al., No. 2019-KA-0281, La. App., 4th Cir., 2019 La. App. LEXIS 1327).

  • July 31, 2019

    Panel Upholds $13.4M Restitution Order For Workers’ Compensation Premium Fraud

    SANTA ANA, Calif. — A California appeals panel on July 23 affirmed a trial court judge’s ruling ordering a man convicted on 33 counts of insurance premium fraud to pay $13.4 million in restitution, finding that the judge properly calculated the amount based on information presented by the defendant’s expert (People v. Michael Vincent Petronella, No. G054524, Calif. App., 4th Dist., 3rd Div., 2019 Cal. App. Unpub. LEXIS 4916).

  • July 30, 2019

    Judge: Record Unclear If Remodeling Company Intended To Defraud Insurer

    JOHNSTOWN, Pa. — A federal judge in Pennsylvania on July 29 denied a workers’ compensation insurance provider’s motion for partial summary judgment on its claim that a remodeling company violated the Pennsylvania Insurance Fraud statute, ruling that genuine disputes exist as to whether the company intended to defraud the insurer (American Builders Insurance Co. v. Custom Installations Contracting Services Inc., et al., No. 15-cv-295, W.D. Pa., 2019 U.S. Dist. LEXIS 125373).

  • July 29, 2019

    Judge Remands Insurance Fraud Suit Over AbbVie’s Marketing Of Humira

    SAN FRANCISCO — A federal judge in California on July 24 remanded a lawsuit accusing AbbVie Inc. of violating California’s Insurance Fraud Prevention Act when marketing Humira by paying kickbacks to doctors who prescribed the autoimmune disorder treatment, finding that the state is a real party in interest (California ex rel. Lazaro Suarez v. AbbVie Inc., No. 18-cv-06392-JD, N.D. Calif., 2019 U.S. Dist. LEXIS 124463).

  • July 22, 2019

    DOJ:  Podiatrist Sentenced To 1 Year, 1 Day In Prison For Fraud

    NEW YORK — The U.S. Department of Justice announced that a federal judge in New York on July 19 sentenced a podiatrist who pleaded guilty to health care fraud to one year and one day in prison for his role in a scheme that involved fraudulently billing insurance companies for services that were never performed (United States v. Hal Abrahamson, No. 18-cr-314, E.D. N.Y.).

  • July 22, 2019

    5th Circuit Upholds Dismissal Of Dentist, Office Employees’ False Claims Act Suit

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on July 19 upheld the dismissal of a False Claims Act (FCA) suit brought by a dentist and an office employee accusing a dental services practice of submitting false bills to Medicare, ruling that a federal judge in Texas did not err when dismissing their suit after they filed to timely amend their action to include federal retaliation claims under the act (United States, ex rel. Philip M. Lin, et al. v. NCDR LLC, et al., No. 18-50653, 5th Cir.).

  • July 19, 2019

    7th Circuit:  Government Properly Calculated Amount Of Loss From Fraud Scheme

    CHICAGO — A Seventh Circuit U.S. Court of Appeals panel on July 18 affirmed a chiropractor’s five-year prison sentence for submitting fraudulent bills to Medicare and private insurers for deceased patients or treatments that were never provided, finding that the government did not err when finding that the man’s scheme resulted in an amount of loss of $4 million (United States v. Henry Posada, No. 18-1586, 7th Cir., 2019 U.S. App. LEXIS 21299).

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