Mealey's Insurance Fraud
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June 17, 2022
Judge Strikes Report Of Expert Witness On Billing In Insurance Fraud Dispute
TAMPA, Fla. — A Florida federal judge on June 14 agreed to strike a report and exclude testimony at trial in an insurer’s suit seeking to recover $2.1 million for allegedly fraudulent no-fault insurance charges, finding a violation of Federal Rule of Civil Procedure 26 because an expert witness retained by a health care clinic and its personnel “did not substantially participate in preparing the Report.”
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June 17, 2022
Hospital Refutes Amicus’ Assertion That Court Order ‘Guts’ California’s IFPA
LOS ANGELES — A hospital on May 5 filed an answer to The Anti-Fraud Alliance’s amicus curiae brief in support of the state of California in a qui tam lawsuit alleging that the hospital participated in kickbacks, patient steering and billing fraud schemes, contending that nothing in the amicus brief provides any basis to warrant reversal of a lower court’s judgment in its favor in the action brought under the California Insurance Frauds Prevention Act.
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June 08, 2022
Michigan Panel Finds Questions Of Fact Over Insurance Fraud
DETROIT — A Michigan appellate court on June 2 vacated and remanded a trial court’s opinion granting summary disposition in favor of insurance companies, finding that there were questions of fact regarding fraud, rescission and ownership in a case where the owner of a medical transportation company suffered injuries in a car accident while operating a company-owned vehicle in his capacity as an employee of the company.
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June 08, 2022
N.J. High Court To Review Application Of Comparative Negligence Act In Fraud Case
TRENTON, N.J. — The New Jersey Supreme Court on June 6 granted certification of an appellate court ruling vacating a multimillion-dollar judgment against insureds in a workers’ compensation fraud case and remanding for a new trial, agreeing to review whether the Comparative Negligence Act applies and whether the jury instructions should have included an ultimate outcome charge.
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June 08, 2022
Questions Of Fact Exist Regarding Insured’s Alleged Misrepresentations, Judge Says
SEATTLE — A Washington federal judge on May 20 determined that questions of fact exist as to whether an insured who is seeking coverage for fire damages to his home intentionally started the fire and whether the insured misrepresented the condition of his home and the contents inside of the home before the damages incurred by the fire.
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June 08, 2022
Judge Refuses To Vacate Judgment Against Insured In Workers’ Comp, Fraud Suit
NEW YORK — A New York federal judge on May 31 denied an insured’s motion to vacate a default judgment and a $1.6 million judgment entered in favor of a workers’ compensation insurer in a breach of contract and fraud suit after determining that the insured was properly served and failed to offer any meritorious defenses for not responding to the complaint.
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June 08, 2022
Homeowners Insurer Is Entitled To Restitution; Policy Properly Rescinded
DETROIT — A homeowners insurer is entitled to reimbursement for a payment made to an insured following a fire at the insured’s home because the insurer properly rescinded the policy based on a misrepresentation made by the insured and is entitled to restitution as an equitable remedy for the rescission of the policy, a Michigan federal judge said May 19.
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June 08, 2022
Panel Affirms $4.5M Judgment Against Insurer That Failed To Prove Fraud
KANSAS CITY, Mo. — A Missouri appellate panel on May 31 affirmed a trial court’s judgment against an insurer for $4.5 million awarded to a driver involved in a collision with an insured’s vehicle, finding that the insurer did not meet its burden of proving a fraudulent insurance act even though a noninsured driver operated the vehicle and waived its right to rescind the policy before the collision.
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June 08, 2022
Relator Award Of $533,007 Appealed In $32M Health Care False Claims Verdict
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on May 16 ordered briefing to begin June 27 in an appeal by five health care defendants of a March 30 award of $533,007 in relator fees, expenses and costs in a false claims case that resulted in $32 million in treble damages.
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June 08, 2022
Panel: Property Owner Not Entitled To Coverage For Fire Damage To Bar
DETROIT — A Michigan Court of Appeals on May 12 found that an insurer is not liable to a property owner additional insured for fire damage to a bar on its property, reversing a lower court, but affirmed the lower court’s ruling that the insurer is entitled to summary judgment on the property owner’s claim for reformation of the policy to include coverage for property damage.
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June 08, 2022
Health Provider Again Urges High Court Review Of FCA Dispute, Disputes Government
WASHINGTON, D.C. — In the wake of the United States’ May 24 amicus brief urging the U.S. Supreme Court not to review the pleading standard in a similar False Claims Act (FCA) case, a health care services provider on May 31 filed a supplemental brief in its own appeal, disagreeing with the government and urging the court to grant review or at least hold the case pending the disposition of the other case.
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June 07, 2022
Insurer Seeks Reconsideration Of Michigan Panel’s Ruling In Suit Over PIP Claims
LANSING, Mich. — An insurer on June 2 moved for reconsideration of a Michigan appeals court’s May 12 ruling that the insurer cannot rescind an automobile insurance policy and cannot “flatly reject” any of its insured’s claims for attendant care or replacement services in a coverage dispute over personal injury protection (PIP) benefits.
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June 07, 2022
Life Insurer Granted Judgment; Policy Voided For Material Misrepresentations
MIAMI — A federal judge in Florida on April 28 granted summary judgment to an insurer seeking a declaration that a life insurance policy it issued is void, agreeing with the insurer that the insured, who died less than two years after the policy was issued, made material misrepresentations in his insurance application regarding his medical history and use of alcohol and other substances.
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June 07, 2022
State Court Stay Denial Warrants Reconsideration, State Farm Says
BROOKLYN, N.Y. — A decision not to stay hundreds of state court lawsuits empowers medical providers accused of unlawfully obtaining insurance for unnecessary health care services to profit off the process and is wrong on the law, plaintiffs tell a federal judge in New York in seeking reconsideration on June 2.
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June 03, 2022
Beneficiary Appeals Summary Judgment Ruling For Life Insurer To 7th Circuit
CHICAGO — A life insurance beneficiary on April 12 appealed an Illinois federal court’s March 30 finding that her husband’s cancer diagnosis was material to the risk undertaken by the insurer and that he misrepresented his health when he received the policy or the policy never went into effect because he did not sign the delivery receipt.
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June 02, 2022
Parties To Windshield Claim Fraud Case Denied Attorney Fees, For Now
TAMPA, Fla. — A federal judge in Florida on May 18 adopted a recommendation denying several motions for attorney fees, saying a pending appeal in a case alleging that a company submitted fraudulent windshield repair claims renders such awards unwarranted and could only complicate the judicial process.
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June 01, 2022
Judge Won’t Dismiss Insurance Fraud Claims Against Chiropractors’ Clinics, Staff
TAMPA, Fla. — A group of chiropractors, other medical professionals and staff and five affiliated clinics on May 24 filed answers in a Florida federal court denying an insurer’s claims that they participated in a five-year $2.1 million scheme to collect fraudulent no-fault automobile insurance benefits after the court on May 3 rejected all of their arguments for dismissal of the claims.
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June 03, 2022
United States: High Court Should Not Review Dismissal Of FCA Suit Against Hospice
WASHINGTON, D.C. — Saying the “divergent outcomes” the petitioners “view as evidence of disarray simply reflect courts’ application of a fact-intensive standard to a range of different allegations,” the United States in a May 24 brief says the U.S. Supreme Court should not review the dismissal of the petitioners’ False Claims Act (FCA) lawsuit against a hospice that allegedly paid illegal kickbacks to physicians for referrals and submitted fraudulent claims to Medicare, noting that “it is unlikely that further review by this Court would produce greater uniformity or materially clarify the Rule 9(b) pleading standard for FCA complaints.”
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June 03, 2022
GEICO Voluntarily Dismisses Named, Doe Defendants In No-Fault Billing Suit
BROOKLYN, N.Y. — Weeks after a federal judge in New York granted a preliminary injunction barring medical equipment suppliers and their owners from commencing any new no-fault collection arbitrations or state collection lawsuits against Government Employees Insurance Co. (GEICO) and certain of its related entities, the insurers on May 23 stipulated to the dismissal without prejudice of their racketeering, common-law fraud and unjust enrichment claims against the named defendants; the next day, they stipulated to the dismissal of John Doe defendants 1-10.
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June 02, 2022
Misrepresentations In Contractor’s Insurance Application Deemed Material
NASHVILLE, Tenn. — A federal judge in Tennessee on May 31 awarded an insurer summary judgment in its suit seeking a declaration that it has no duty to defend or indemnify a contractor insured in an underlying suit over defects in the construction of a firearms store and shooting range’s concrete pad, ruling that there are no material issues of fact about whether the contractor made material misrepresentations in his application for insurance.