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Mealey's Insurance Fraud

  • April 5, 2019

    Michigan Panel Reverses Ruling Applying Fraud Preclusion To Deny Coverage

    GRAND RAPIDS, Mich. — A Michigan appeals court panel on April 2 vacated a trial court judge’s ruling awarding summary judgment to an insurance company that denied coverage for a woman’s claim for no-fault personal injury protection (PIP) benefits for injuries she sustained in an automobile accident, holding that the judge erred when finding that the evidence supported the insurer’s claim that the woman’s injuries did not stem from the accident (Denise Gable v. Citizens Insurance Company of the Midwest, No. 341757, Mich. App., 2019 Mich. App. LEXIS 634).

  • April 2, 2019

    Former Account Representative Sentenced To 56 Months In Prison For Fraud

    MCALLEN, Texas — A federal judge in Texas sentenced a former toxicology testing company account representative to 56 months in prison for his role in a scheme to falsify patient records and submit urine specimens for testing at a medical clinic in order to receive commissions and collection fees from the testing company, according to a docket entry dated March 20 (United States v. Omar Solis, et al., No. 17cr1046, S.D. Texas).

  • March 22, 2019

    Counseling Services Center, Owners Not Liable For False Claims Act Violations

    LITTLE ROCK, Ark.— A federal judge in Arkansas awarded summary judgment to a mental health services center and its owners after finding that plaintiffs leading a qui tam action under the False Claims Act (FCA) failed to present evidence that the owners were in violation of the state’s Medical Corporation Act (MCA), and that any bills submitted by the center and its franchises were fraudulent (United States, ex rel. Jacqueline Clemente, et al. v. Lead Teach Mentor LLC, et al., No. 16CV00875, E.D. Ark., 2019 U.S. Dist. LEXIS 45786).

  • March 20, 2019

    Defendants’ Request For Court To Abstain From Fraudulent Billing Suit Denied

    DETROIT — A federal judge in Michigan on March 18 denied a motion to dismiss Allstate Insurance Co.’s claims for declaratory relief and violation of the Racketeer Influenced and Corrupt Organizations Act against four doctors and two clinics accused of submitting fraudulent bills for medical services that were unnecessary and unreasonable, holding that the defendants failed to establish why the court should abstain from jurisdiction (Allstate Insurance Co., et al. v. Orthopedic P.C., et al., No. 18-cv-10193, E.D. Mich., 2019 U.S. Dist. LEXIS 43171).

  • March 18, 2019

    High Court Will Not Address Pleading Standards In False Claims Act Suit

    WASHINGTON, D.C. — The U.S. Supreme Court on March 18 denied a nursing facility’s petition for a writ of certiorari and refused to review a Sixth Circuit U.S. Court of Appeals ruling that revived a woman’s False Claims Act (FCA) lawsuit accusing it of submitting fraudulent bills to Medicare on the ground that she sufficiently pleaded materiality and scienter (Brookdale Senior Living Communities Inc. v. United States, ex rel. Marjorie Prather, No. 18-699, U.S. Sup.).

  • March 14, 2019

    Home Health Therapy Services Owner, Worker Sentenced For Health Care Fraud

    MIAMI — The owner of a home health therapy services company and an employee who performed services despite not being licensed to do so were sentenced by a federal judge in Florida on March 6 after they pleaded guilty to charges of engaging in an $8.6 million health care fraud scheme (United States v. Alexander Ros Lazo, et al., No. 18cr20536, S.D. Fla.).

  • March 14, 2019

    Judge Sentences Woman To 20 Years In Prison For Health Care Fraud

    HOUSTON — A woman who was convicted in September 2017 on charges of conspiring to commit health care fraud and health care fraud was sentenced by a federal judge in Texas March 8 to 20 years in prison and ordered to pay $15 million in restitution (United States v. Aliksandar Bekatev, et al., No 14cr637, S.D. Texas).

  • March 14, 2019

    Woman Sentenced To 21 Months For Illegally Obtaining Disability Benefits

    TAMPA, Fla. — A federal judge in Florida on March 8 sentenced a woman to 21 months in prison and ordered her to pay restitution for illegally obtaining Social Security disability benefits while simultaneously working at a law firm as a title closer (United States v. Roselle Fitzgerald, No. 18cr227, M.D. Fla.).

  • March 13, 2019

    Woman’s Conviction For Disability Insurance Scheme Upheld By 9th Circuit

    PASADENA, Calif. — A Ninth Circuit U.S. Court of Appeals panel on March 12 affirmed a former sales associate’s conviction for mail fraud and witness tampering in connection with her role in orchestrating a scheme to submit fraudulent claims for disability insurance benefits from American Family Life Assurance Co. (AFLAC), finding that the evidence sufficiently demonstrated that she attempted to corruptly persuade witnesses to not speak with investigators (United States v. Patricia Diane Smith Sledge, No. 17-50363, 9th Cir., 2019 U.S. App. LEXIS 7116).

  • March 13, 2019

    Jury Should Hear Insurance Fraud Prevention Suit, New Jersey Panel Rules

    TRENTON, N.J. — A jury should decide if a California chiropractor and two of his clinics violated the Insurance Fraud Prevention Act (IFPA) when opening clinics in New Jersey and submitting claims for reimbursement to insurance companies, a New Jersey appeals court ruled March 11, finding that the ruling in Allstate New Jersey Ins. Co. v. Lajara can be applied retroactively (Allstate Insurance Co., et al. v. Northfield Medical Center P.C., et al., No. A-0964-12T4, N.J. Super., App. Div.,2019 N.J. Super. Unpub. LEXIS 572).

  • March 12, 2019

    New Jersey Appeals Court Vacates Portion Of Fraud Ruling Against Doctor

    TRENTON, N.J.— A New Jersey appeals court panel on March 8 vacated a trial court judge’s ruling finding that a radiologist violated two sections of the New Jersey Insurance Fraud Prevention Act (IFPA), holding that expert testimony is needed to determine if there was a relationship between a patient’s prior medical history and the reason the patient was undergoing the procedure performed by the radiologist (Allstate New Jersey Insurance Co., et al. v. Gregorio Lajara, et al., No. A-1151-16T4, N.J. Super., App. Div., 2019 N.J. Super. Unpub. LEXIS 523).

  • 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 6, 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 4, 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 4, 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.).