Mealey's Insurance Fraud
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January 13, 2021
Man’s Arguments To Vacate Conviction For Restaurant Fire ‘Meritless,’ Judge Finds
PROVIDENCE, R.I. — A federal judge in Rhode Island on Jan. 12 refused to vacate a man’s sentence for wire fraud, using fire to commit wire fraud and arson of a building involving interstate commerce, overruling his arguments for ineffective assistance of counsel, actual innocence and alleged misconduct by law enforcement.
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January 03, 2021
9th Circuit Affirms Clinic Owner’s Aggravated Identity Theft Conviction
SAN FRANCISCO — A Ninth Circuit U.S. Court of Appeals panel on Dec. 29 affirmed a speech pathology clinic owner’s conviction on two counts of aggravated identity theft, finding that the defendant’s submission of fraudulent bills to TRICARE, a government health care program for military members, military retirees and their families, which included a speech pathologist’s name and national provider identifier (NPI) number for services that were not provided to two pediatric patients, constituted use under the aggravated identity theft statute.
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December 23, 2020
New Jersey Panel Affirms Ruling Ordering Speech Pathologist To Sign Settlement
JERSEY CITY, N.J. — A two-judge New Jersey appeals panel on Dec. 16 upheld a ruling ordering a speech-language pathologist to sign a settlement agreement with an insurance company that accused her of submitting fraudulent claims, finding that the defendant agreed to the terms of the settlement under oath and that her ability to discharge the debt of the settlement during bankruptcy did not need to be considered when granting the motion.
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December 22, 2020
California Panel: Qui Tam Suit Over Billing Practices Not Subject To Arbitration
VENTURA, Calif. — A California appeals court on Dec. 21 upheld a ruling denying a motion to compel arbitration filed by doctors and clinics accused of fraudulently billing Aetna Health of California Inc. and an affiliate, finding that the insurer’s qui tam cause of action brought under the Insurance Fraud Protection Act (IFPA) is not subject to arbitration because the state of California did not sign any of the contracts between the parties (California, ex rel. Aetna Health of California Inc. v. Pain Management Specialist Medical Group, et al., No. B299025, Calif. App., 2nd Dist., 6th Div., 2020 Cal. App. LEXIS 1208).
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December 18, 2020
Judge Enters $3.2M Monetary Judgment Against Hospice Executive Convicted Of Fraud
BROWNSVILLE, Texas — A federal judge in Texas on Dec. 16 entered a $3.2 million monetary judgment against an executive of a chain of hospice companies that was convicted in November 2019 of health care fraud, as well as paying and receiving illegal kickbacks as part of a $150 million scheme that involved falsely telling patients with long-term diseases that they had only six months to live, finding that the amount was equal to the proceeds he obtained from his conduct.
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December 17, 2020
Judge Denies Reconsideration Of Fraud Defendant’s Compassionate Release Denial
NEW YORK — A federal judge in New York on Nov. 30 refused to reconsider a ruling denying an insurance fraud defendant’s request for compassionate release in light of the COVID-19 pandemic, finding that the seriousness of the man’s offenses militates against release.
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December 16, 2020
Fraud Defendant’s Renewed Motion For Compassionate Release Denied; Appeal Filed
NEW YORK — A federal judge in New York’s Dec. 15 ruling denying an insurance fraud defendant’s renewed motion for compassionate release on the ground that the heightened prevalence of COVID-19 at the correctional institution where he is housed is still not a compelling reason for early release prompted the defendant to file a notice of appeal on Dec. 16.
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December 16, 2020
State Farm Awarded Costs After Judge Denies Fraud Defendants’ Discovery Request
DETROIT — A federal judge in Michigan on Nov. 30 awarded costs to State Farm Mutual Automobile Insurance Co. after denying a motion to compel filed by defendants accused of submitting claims for medically unnecessary services or treatments that were not performed on the ground that the insurer had already produced information about the terms of the policies held by its insureds.
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December 15, 2020
Judge Dismisses Insurer’s RICO Suit Over Billing Scheme, Denies Default Judgment
NEW YORK — A federal judge in New York on Dec. 14 dismissed an insurer’s Racketeer Influenced and Corrupt Organizations (RICO) Act lawsuit against a number of medical providers and clinics over 15 alleged fraudulent billing schemes after finding that the allegations in the complaint could not support the insurer’s request for default judgment and because the allegations lacked specificity regarding the schemes.
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December 15, 2020
GEICO Entitled To Injunctive Relief In Fraudulent Billing Suit, Judge Rules
NEW YORK — A federal judge in New York on Dec. 1 granted a motion filed by the Government Employees Insurance Co. (GEICO) and its affiliates seeking injunctions to stay 2,430 arbitration proceedings brought by medical providers accused of submitting claims for urine drug screenings that were not medically necessary and bar the providers from filing future proceedings until the lawsuit is resolved, finding that the insurer will suffer irreparable harm if the relief is not granted.
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December 09, 2020
Suit Over Progressive Lens Maker’s Rewards Program Cannot Be Amended, Judge Says
LOS ANGELES — A federal judge in California on Dec. 4 denied a relator’s motion for leave to amend his False Claims Act (FCA) lawsuit accusing makers of progressive optic lenses of engaging in an illegal kickback scheme through their use of a rewards program to eye care professionals, finding that the proposed new allegations were vague and based on sealed documents that were not properly admitted as exhibits.
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December 09, 2020
Magistrate Says Expert Witness Can Testify That Doctor Committed Insurance Fraud
MIAMI — After questioning a doctor’s “decision to cherry-pick portions of cases to support” his arguments that an insurance company’s expert witness should be prohibited from testifying in an insurance fraud case, a Florida federal magistrate judge on Dec. 1 denied his motion to strike (GEICO v. Luis Lopez Mas, et al., No. 19-21183, S.D. Fla., 2020 U.S. Dist. LEXIS 224248).
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December 04, 2020
Magistrate Orders Clinic To Ask Employees, Contractors For Business Emails
DETROIT — A federal magistrate judge in Michigan on Dec. 2 granted in part a motion to compel filed by State Farm Mutual Automobile Insurance Co., by ordering a clinic accused of submitting bills for medically unnecessary treatments to formally ask its current employees and contractors to search their emails for business records that are responsive to the requests for production and allowing the insurer to subpoena Google for metadata from three email accounts associated with the clinic’s employees.
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December 02, 2020
6th Circuit Agrees Relator Was Not Original Source Of Medicare Fraud Scheme
CINCINNATI — A federal judge in Tennessee’s dismissal of a relator’s False Claims Act (FCA) lawsuit was affirmed by the Sixth Circuit U.S. Court of Appeals on Dec. 1, after finding that the relator was not an original source of an alleged scheme involving the submission of fraudulent bills to Medicare for cardiac procedures and that the relator’s qui tam suit was precluded by the public disclosure bar.
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November 24, 2020
Illinois High Court: Bankruptcy Estate Can Pursue Claims Over Fraudulent Billing
SPRINGFIELD, Ill. — The Illinois Supreme Court on Nov. 19 affirmed an appeals court’s ruling that the trustee of a bankruptcy estate for a woman who worked for an optometrist’s office that allegedly submitted fraudulent bills to a private insurer can pursue a claim under the state’s insurance fraud act, holding that the appeals panel did not err when finding that the woman is an “interested person” under the act and that the state could assign its claim to the bankruptcy estate because the state suffered an “injury in fact” to its sovereignty as a result of the office’s alleged conduct.
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November 23, 2020
Home Health Agency, Executives To Pay $5.8M To Resolve Medicare Billing Suits
WASHINGTON, D.C. — The U.S. Department of Justice announced Nov. 20 that a home health care agency and two of its executives agreed to pay $5.8 million to resolve allegations brought by former employees under the qui tam provisions of the False Claims Act (FCA), in two lawsuits in federal court in Florida accusing the defendants of engaging in a scheme to fraudulently bill Medicare for unnecessary medical treatments to elderly patients to avoid the government insurer’s low utilization payment adjustment (LUPA).
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November 18, 2020
11th Circuit Affirms Former Football Player’s Fraud Conviction, Vacates Sentence
ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Oct. 22 affirmed a former professional football player’s conviction for conspiracy to commit health care fraud and wire fraud, finding that the evidence was sufficient to show that he knowingly operated a business that sold medically unnecessary compounded medications, but overturned his 20-year prison sentence because it exceeded the 10-year statutory maximum for health care fraud.
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November 18, 2020
Fraud Defendant’s 2nd Request To Stay Insurer’s Suit Pending Sentencing Denied
DALLAS — A federal judge in Texas on Nov. 17 denied a doctor’s second request to stay or abate a civil action brought by Cigna Healthcare of Texas Inc. and other insurers over an alleged fraudulent billing scheme, finding that there is not enough overlap between the civil action and a criminal proceeding against him to warrant a stay and because allowing the cases to proceed simultaneously will not adversely affect his rights under the Fifth Amendment to the U.S. Constitution.
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November 16, 2020
Judge Says Long-Term Care Policy Void, Awards Insurer Damages For Misrepresentations
LOS ANGELES — A federal judge in California on Nov. 13 entered a declaratory judgment in favor of an insurer that contended that a couple’s long-term care (LTC) policy should be voided after it learned that they were submitting falsified bills and awarded the company $919,290.49 in compensatory and punitive damages based on a jury’s August 2018 verdict in the company’s favor.
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November 13, 2020
Magistrate Denies GEICO’s Request To Quash Fraud Defendant’s Subpoena
NEW YORK — A federal magistrate judge in New York on Nov. 12 denied a motion to quash filed by insurers that sought to prevent disclosure of communications regarding settlement negotiations between the companies and a former defendant who was employed by a clinic accused of submitting fraudulent bills, finding that the information is not privileged and can be used by the remaining defendants to examine the individual’s bias, credibility, motive and prejudice.