PHILADELPHIA — Drug manufacturer Incyte Corp. has agreed to pay $12.6 million to settle a false claims lawsuit alleging that it paid kickbacks in the form of patient drug co-pays in exchange for health care providers prescribing the company’s chemotherapy drug Jakafi, according to a May 4 press release by the U.S. Justice Department.
JASPER, Ala. — A federal judge in Alabama on April 29 denied a motion for acquittal filed by a convicted compounding pharmacy’s sales manager, finding that his testimony, demeanor and credibility provided sufficient evidence to support the jury’s finding that he intended to conspire to commit health care fraud and committed health care fraud when participating in a scheme to submit bills to insurance companies for prescriptions for his employer’s drugs that were not medically necessary.
TAMPA, Fla. — A federal judge in Florida on April 20 dismissed claims brought by State Farm Mutual Automobile Insurance Co. and State Farm Fire and Casualty Co. (collectively, State Farm) against a holding company that owns a medical clinic accused of illegally referring patients for medically unnecessary services and submitting bills to the insurer, finding that the complaint does not provide the company with sufficient notice of its wrongdoing, and found that State Farm failed to state claims for unjust enrichment and violation of Florida’s Patient Self-Referral Act.
NEW YORK — A New York justice on April 19 denied State Farm Fire and Casualty Co.’s motion for summary judgment in a suit over its requirement to pay a medical provider for services performed on an insured following an automobile accident, finding that the insurer was unable to show that the untimely denial of the insured’s claim was warranted and that injuries were not the result of the accident.
ATLANTA — The 11th Circuit U.S. Court of Appeals on April 26 affirmed the dismissal of a False Claims Act (FCA) lawsuit accusing a hospice of engaging in a scheme that paid illegal kickbacks to physicians who referred patients to its care and then submitted fraudulent claims to Medicare, finding that the allegations in the relators’ complaint did not satisfy the heightened pleading requirement of Federal Rule of Civil Procedure 9(b) and that the relators lacked sufficient knowledge of the scheme that could give rise to some indicia of reliability.
ATLANTA — The 11th Circuit U.S. Court of Appeals on April 21 affirmed a federal judge’s decision to sentence the owner of a durable medical equipment company to 121 months in prison after she was found guilty of health care fraud for submitting altered and falsified documents to Medicare, overruling the woman’s arguments that the judge erred during the trial and when finding that the scheme involved sophisticated means.
NEW YORK — A federal judge in New York on April 20 denied the government’s request to require a doctor who pleaded guilty to conspiracy to commit health care fraud to forfeit the $6.8 million insurance companies paid to his cardiology and neurology clinic as part of a fraudulent billing scheme, finding that there was insufficient evidence to show that the clinic owner directly or indirectly obtained the proceeds of the scheme.
AIKEN, S.C. — A federal judge in South Carolina on April 19 refused to reconsider a ruling that the reduction of a 60-month prison sentence against a man who pleaded guilty to conspiring to engage in an insurance fraud scheme was unnecessary, finding that he was rehashing arguments from this third motion for compassionate release in which he claimed that his medical conditions were extraordinary and compelling reasons for compassionate release in light of the COVID-19 pandemic.
ST. LOUIS — An Eighth Circuit U.S. Court of Appeals panel on April 16 vacated a jury verdict against an insurer for vexatious failure to pay a claim filed by a couple the company accused of intentionally starting a fire, finding that the trial court judge erred by excluding evidence of the man’ prior convictions for three felonies.
SANTA ANA, Calif. — A 2-1 California appeals panel on April 14 affirmed a judge’s order requiring a former police officer convicted of filing a false workers’ compensation claim to pay $75,427.67 in restitution, with the dissenting judge arguing that the officer should not have to repay $7,782.56 in insurance premiums that were paid by the city of Costa Mesa, Calif., while he was recovering from surgery to remove a brain tumor because it was not tied to his criminal activity.
DETROIT — State Farm Mutual Automobile Insurance Co. says in objections filed in federal court in Michigan on April 7 that a magistrate judge erred when partially denying its request for sanctions that would have required the owners of three clinics accused of submitting fraudulent claims of providing emails from two accounts, arguing that the magistrate judge erroneously relied on their testimony to find that the accounts were not used for business purposes.
NEW YORK — A federal judge in New York on March 25 granted in part a motion filed by Government Employees Insurance Co. (GEICO) and its affiliates seeking to enjoin proceedings and the filings of new arbitration actions seeking reimbursement under the state’s no-fault insurance law for services provided by defendants accused of submitting fraudulent claims, finding that the injunction should be limited to services billed under certain current procedural terminology codes (CPT codes) mentioned in the insurers’ amended complaint.
JERSEY CITY, N.J. — A trial court judge did not err when sustaining a prosecutor’s rejection of a staged slip-and-fall victim’s request for entry into a pretrial intervention program (PTI program) despite disagreeing with the decision, a New Jersey appeals court panel ruled April 14, finding that the prosecutor considered all relevant factors when vetoing the request.
ST. LOUIS — A federal judge in Missouri on April 7 adopted a magistrate judge’s recommendation to deny dismissal of a 24-count second superseding indictment accusing a couple who owned a pain clinic of purchasing Orthovisc from a Canadian pharmacy, providing it to patients and submitting bills to government insurers for the treatment, finding that the claims for selling a misbranded device and selling an adulterated device were not duplicitous and that the charges for health care fraud were sufficient.
DETROIT — A federal magistrate judge in Michigan on April 12 refused to impose a $5,000 monetary sanction against a clinic over its failure to satisfactorily comply with a request from State Farm Mutual Automobile Insurance Co. to supplement its discovery response to emails from a specific account and reduced the bill of costs sought by the insurer after finding that the hourly rate for one of the insurer’s attorneys was not reasonable.
RICHMOND, Va. — A Fourth Circuit U.S. Court of Appeals panel on April 9 affirmed the convictions of three defendants found guilty on charges of conspiracy to commit wire fraud and bank fraud and conspiracy to commit money laundering, finding that the evidence sufficiently showed that their insurance fraud scheme affected a financial institution and that evidence of one of the defendant’s involvement in a similar scheme was properly admitted to show that he knew that his actions were unlawful.
PHILADELPHIA — Admittedly altered invoices from an auto repair shop that inflated replacement costs for inventory damaged by water constituted material misrepresentations that supported awarding summary judgment to an insurer on its claims for declaratory judgment and violation of the Pennsylvania Insurance Fraud Act (IFA) but did not satisfy all of the elements for common-law fraud, a federal judge in Pennsylvania ruled April 12.
RICHMOND, Va. — A blood-testing clinic owner and two salesmen say in a petition for rehearing filed in the Fourth Circuit U.S. Court of Appeals on April 8 that the court’s Feb. 22 ruling affirming a jury’s $114 million judgment against them for violating the anti-kickback statute (AKS) and False Claims Act (FCA) should be reviewed en banc because it “is not merely wrong; it is unjust” and conflicts with decisions of the court and the U.S. Supreme Court.
BOSTON — A state court judge in Massachusetts on Feb. 22 denied a motion by two insurance companies seeking $4.6 million in prejudgment security against two founders of a behavioral services clinic for high-functioning autistic children accused of fraudulently billing the companies, finding that the insurers did not provide sufficient evidence showing that bills submitted by the clinic were fraudulent and denied the clinic’s motion for a preliminary injunction that would bar the insurers from removing them as an in-network provider.
GULFPORT, Miss. — A federal judge in Mississippi on March 26 denied in part State Farm Fire and Casualty Co.’s motion to dismiss certain claims in relators’ second amended complaint in their 15-year-old qui tam suit accusing the insurer of filing false flood insurance claims after Hurricane Katrina, finding that the relators have plausibly and sufficiently asserted express and implied false certification claims.