Mealey's Insurance Fraud
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May 24, 2022
Washington High Court To Hear Arguments On Life Insurance Incontestability Clause
OLYMPIA, Wash. — The Washington Supreme Court will hear oral arguments on June 14 about whether a group life insurer may obtain a declaratory judgment that a policy is void as fraudulently obtained even though the policy contains a clause, pursuant to state law, that the policy may not be contested after it has been in force for two years, other than for nonpayment of premiums.
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May 23, 2022
Life Insurance Holder May Amend Answer To Allege Fraud, Judge Says
GREENVILLE, N.C. — The holder of a life insurance policy may amend its answer to allege additional facts learned in discovery and add a claim for fraud, a North Carolina judge said May 3 after finding that waiting until discovery did not constitute undue delay, that there would be no prejudice and that the amendment was not futile.
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May 20, 2022
Clinic Owner’s Motion To Stay Pending Appeal Denied In Fraudulent Billing Suit
DETROIT — A federal judge in Michigan on May 14 refused to stay pending appeal his opinion granting a no-fault auto insurer’s motion to enforce the terms of a prior settlement by requiring the owner of a group of medical clinics alleged to have orchestrated a fraudulent no-fault billing scheme to dismiss a qui tam action against the insurer, finding that the owner has not met his burden of showing any serious questions going to the merits of the ruling, which the judge subsequently refused to reconsider.
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May 20, 2022
Insurer Wins Summary Judgment In Fire Claim Suit After Insured Fails To Respond
EAST ST. LOUIS, Ill. — Considering a landlord insured’s failure to respond to its insurer’s motion for summary judgment an admission of the merits of the insurer’s arguments, a federal magistrate judge in Illinois on May 5 granted the insurer summary judgment on its claim that it has no obligation to the insured for damage from two fires at a rental property and dismissed the insured’s breach of contract counterclaim.
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May 19, 2022
Hotel Operator Refutes Insurer’s Motion To Dismiss Appeal For Lack Of Jurisdiction
ATLANTA — A hotel operator insured on May 4 filed a response to an insurer’s motion to dismiss its appeal challenging a lower federal court’s denial of its post-trial motions and motion for a mistrial in an insurance dispute stemming from the insured’s alleged filing of a fraudulent Hurricane Irma commercial property damage claim, disputing the insurer’s argument that the 11th Circuit U.S. Court of Appeals lacks jurisdiction.
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May 18, 2022
Government And Both Parties Move To Amend $1M Judgment In Crop Insurance Case
MINNEAPOLIS — A Minnesota federal judge predicted in a March 30 ruling in a suit over crop insurance that both parties “will take serious issue with the appropriate measure of damages,” and on April 27 they each moved to amend the judgment, as did the government.
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May 16, 2022
Solicitor General Asked To File Brief In High Court FCA Claims Dismissal Appeal
WASHINGTON, D.C. — The U.S. Supreme Court on May 16 invited U.S. Solicitor General Elizabeth B. Prelogar to file a brief expressing the views of the United States in an appeal of a Sixth Circuit U.S. Court of Appeals’ ruling affirming the dismissal of False Claims Act (FCA) claim and related state law claims brought in a qui tam action against a home health agency and others.
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May 13, 2022
Judge Won’t Dismiss Health Insurer’s Suit Against Provider For ‘Upcoding’
KNOXVILLE, Tenn. — A Tennessee federal judge on May 10 denied a motion by a medical staffing company to dismiss a fraud lawsuit filed by a health insurer who claims the defendant was “upcoding” claims, resulting in millions of dollars in overpayment.
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May 13, 2022
Judge Dismisses PIP Benefit Fraud Suit After Parties Reach Settlement
LOUISVILLE, Ky. — A federal judge in Kentucky on May 10 dismissed with prejudice insurers’ lawsuit alleging that a chiropractor and his practice billed them for medically unnecessary services rendered to insureds who were eligible for personal injury protection (PIP) benefits, a day after the parties submitted a joint status report indicating that they had reached a settlement (State Farm Mutual Automobile Insurance Co., et al. v. Injury Care Chiropractic LLC, et al., No. 20-819, W.D. Ky.).
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May 13, 2022
Judge Won’t Dismiss $5.9M MRI Fraud Case, Orders Arbitration Of Some Claims
NEWARK, N.J. — A New Jersey federal judge on May 11 declined to dismiss claims for violation of the New Jersey Insurance Fraud Prevention Act (NJIFPA), N.J.S.A. 17:33A-1 et seq., brought by Government Employees Insurance Co. (GEICO) and three related entities against radiology facility defendants accused of fraudulently billing more than $5.9 million for no-fault insurance claims, but compelled arbitration of certain fraud-related claims under GEICO’s “broad arbitration agreement” with providers.
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May 10, 2022
Insurer: Insured’s Delay In Providing Support For Claim Delayed Investigation
TALLAHASSEE, Fla. — An insurer recently argued that a condominium association insured’s delay in providing the required documentation and other support for its claim for more than $40 million in Hurricane Irma damage necessarily delayed its investigation, reinforcing its challenge of an appeals court’s ruling that affirmed granting the insured’s motion to compel appraisal.
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May 06, 2022
Policy Rescission Proper Based On Insured’s Material Misrepresentations
FORT PIERCE, Fla. — A federal judge in Florida on April 28 ruled that an insurer is entitled to summary judgment in a declaratory judgment lawsuit stemming from its insured’s application for a term-life insurance policy because the undisputed facts show that the insured made several misrepresentations in his policy application regarding his history of substance abuse and that those misrepresentations were material.
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May 05, 2022
Insurer’s Policy Rescission Proper Based On Material Misrepresentations
JERSEY CITY, N.J. — A New Jersey trial court did not err in determining that a woman lacked an “insurable interest” in a rental property after transferring her ownership interest in the property to an LLC she created and failing to notify her fire insurance provider of the transfer in ownership because the woman acknowledged that the policy would not be valid if the insurer did not provide consent prior to the transfer, a New Jersey appellate panel ruled April 19 in affirming.
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May 05, 2022
Judge Declines To Quash Bank Record Subpoenas In Fraudulent Billing Suit
NEWARK, N.J. — A federal judge in New Jersey on April 11 substantially denied a motion to quash five subpoenas served on banks that held accounts with defendants alleged to have taken part in a fraudulent billing scheme for no-fault insurance claims with Government Employees Insurance Co. (GEICO) and three of its related entities, ruling that the information sought in the subpoenas is both “relevant and discoverable.”
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May 05, 2022
Clinic Owner Appeals Reconsideration Denial In Fraudulent Billing Suit
DETROIT — An owner of a group of medical clinics alleged to have orchestrated a fraudulent no-fault automobile insurance billing scheme will appeal a federal judge’s denial of his motion seeking reconsideration of the judge’s previous opinion enforcing the terms of a settlement agreement by requiring the defendant to dismiss a qui tam action against State Farm Automobile Insurance Co., the defendant stated in a notice of appeal filed May 4 in Michigan federal court.
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May 05, 2022
Irreparable Harm Showing Enough To Grant Injunction In No-Fault Billing Suit
BROOKLYN, N.Y. — A federal judge in New York on May 5 issued an amended order granting 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, ruling that the insurers have sufficiently pleaded that, without injunctive relief, they will be irreparably harmed.
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May 05, 2022
Detective Had Probable Cause To Charge Man In Fraudulent Billing Scheme
ATLANTA — A federal district court did not err in dismissing a malicious prosecution claim brought by a chiropractor against the detective who investigated fraudulent billing claims against the chiropractor that eventually led to eight criminal charges in relation to the alleged scheme because the information the detective gathered during his investigation provided him with the necessary probable cause to charge the chiropractor with each of the counts, an 11th Circuit U.S. Court of Appeals panel ruled May 2 in affirming.
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May 03, 2022
Voiding Long-Term Care Policy Inappropriate At This Time, Judge Rules
LOS ANGELES — A federal judge in California on April 15 ruled that although an insured was properly found by a jury to have materially misstated material facts in seeking long-term care benefits for activities of daily living (ADLs) after having knee replacement surgery, voiding her policy based on the alleged misstatements is not warranted.
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May 02, 2022
Relator: Question Presented In FCA Dispute Does Not Warrant Review
WASHINGTON, D.C. — U.S. Supreme Court review of a divided Seventh Circuit U.S. Court of Appeals panel’s ruling that a federal district court erred in dismissing state and federal False Claims Act (FCA) claims against a health care services provider regarding its alleged operation of a Medicaid billing scheme for reimbursement of skilled nursing facilities (SNF) services is not warranted because the question of whether Federal Rule of Civil Procedure 9(b) “requires plaintiffs in False Claims Act case to plead details of the alleged false claims” is not sufficiently presented, a relator argues in an April 27 opposition brief.
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April 28, 2022
Kansas Prosecutors Showed Probable Cause To Bring Insurance Fraud Charges
TOPEKA, Kan. — Both a trial court and a state appellate court erred in ruling that Kansas prosecutors failed to sufficiently establish probable cause to exercise territorial jurisdiction over a man charged with insurance fraud and making a false information stemming from his submission of a fraudulent claim for benefits for injuries allegedly sustained in a motor vehicle accident because those courts incorrectly interpreted and applied Kansas law in reaching their decisions, the Kansas Supreme Court ruled April 22 in reversing and remanding.