Mealey's Insurance Fraud

  • May 06, 2021

    Drug Maker Incyte Pays $12.6M To Resolve False Claims Suit For Drug Co-Pays

    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.

  • May 05, 2021

    Judge Says Man’s Testimony, Evidence Support Insurance Fraud Conviction

    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.

  • May 03, 2021

    Holdings Company, Some Claims Trimmed From State Farm’s Fraudulent Billing Suit

    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.

  • May 03, 2021

    State Farm Unable To Meet Burden For Summary Judgment In Auto Accident Suit

    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.

  • April 28, 2021

    11th Circuit Affirms Dismissal Of Suit Accusing Hospice Of Kickback Scheme

    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.

  • April 22, 2021

    11th Circuit Affirms Woman’s 121-Month Prison Sentence For Medicare Fraud

    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.

  • April 21, 2021

    Judge Finds Clinic Owner Accused Of Fraud Need Not Forfeit $6.8M

    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.

  • April 20, 2021

    Judge Refuses To Reconsider Denial Of Fraud Defendant’s Sentence Reduction Request

    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.

  • April 19, 2021

    8th Circuit Vacates Verdict Against Insurer Over Refusal To Pay Claim

    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.

  • April 16, 2021

    Split California Panel: Officer Convicted Of Fraud Must Repay Insurance Premiums

    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.

  • April 15, 2021

    State Farm Objects To Partial Denial Of Sanctions Request Against Clinics

    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.

  • April 15, 2021

    Judge Pauses Proceedings, Filings Of Some Arbitration Actions Filed Against GEICO

    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.

  • April 14, 2021

    New Jersey Panel Upholds Denial Of Fraud Defendant’s Pretrial Intervention Request

    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.

  • April 14, 2021

    Judge Denies Dismissal Of 2nd Superseding Indictment Against Clinic Owners

    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.

  • April 13, 2021

    Magistrate Slashes Insurer’s Bill Of Costs, Denies Sanctions Against Clinic

    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.

  • April 13, 2021

    4th Circuit: Evidence Supports Convictions Stemming From Insurance Fraud Scheme

    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.

  • April 13, 2021

    Repair Shop’s Altered Invoices Were Material Misrepresentations, Judge Says

    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.

  • April 12, 2021

    Clinic Owner, Salesmen Say 4th Circuit’s Anti-Kickback Statute Ruling Is ‘Unjust’

    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.

  • April 06, 2021

    Judge Denies Insurers’ Motion For $4.6M In Prejudgment Security In Fraud Suit

    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.

  • March 30, 2021

    Judge Allows Certain Claims To Proceed In Relators’ Suit Against State Farm

    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.

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