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Mealey's Insurance Fraud

  • November 6, 2018

    Ophthalmologist Agrees To Pay $2M For Fraudulently Billing Medicare, Medicaid

    NEW YORK — An ophthalmologist and his practice on Nov. 1 agreed to pay $2 million to the federal government to resolve claims brought in New York federal court that he violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for testing that was done so poorly that it lacked any diagnostic value (United States v. Metropolitan Retina Associates Inc., et al., No. 18-cv-9146, S.D. N.Y.).

  • November 6, 2018

    Farmer Charged With Fraud Scheme Against Federal Crop Reinsurer

    LEXINGTON, Ky. — The U.S. government in a Nov. 1 indictment filed in a Kentucky federal court accuses a farmer of fraudulently submitting statements to a government agency that reinsures his crops (United States v. Keith Foley, No. 18-cr-00154, E.D. Ky.).

  • November 2, 2018

    Cardiologist Sentenced To 42 Months In Prison For Health Care Fraud

    LONDON, Ky. — A federal judge in Kentucky on Nov. 1 sentenced a cardiologist to 42 months in prison and ordered him to pay a $50,000 fine and pay $257,515 in restitution to Medicare, Medicaid and private insurers after he was found guilty of health care fraud for implanting pacemakers in patients who did not need them (United States v. Anis Chalhoub, M.D., No. 16-cr-00023-GFHT-HAI, E.D. Ky.).

  • November 1, 2018

    Nurse Practitioner Convicted Of Health Care Fraud, Illegally Distributing Opioids

    MONTGOMERY, Ala. — A federal judge in Alabama on Oct. 29 convicted a nurse practitioner on charges of health care fraud, conspiracy to commit health care fraud, conspiracy to unlawfully sell and distribute controlled substances and unlawfully selling and distributing controlled substances after finding that she falsified medical records to support services that were not provided and forged a physician’s signature to prescribe fentanyl, hydrocodone, oxycodone and alprazolam to patients (United States v. Lillian Akwuba, et al., No. 17-cr-511, M.D. Ala.).

  • November 1, 2018

    Agency Owners, Employees Convicted For Conducting $3.7M Medicare Fraud Scheme

    DALLAS — Two owners of a home health care agency and two of its employees were convicted Oct. 29 by a federal jury in Texas for their roles in a $3.7 million fraud scheme involving the submission of claims to Medicare even though the owners had previously been excluded from participating in federal health care programs (United States v. Celestine Okwilagwe, et al., No. 16cr240, N.D. Texas).

  • October 30, 2018

    Judge Refuses To Suppress Evidence Of Fraud Scheme From Defendant’s Phone

    DETROIT — Evidence from a defendant’s cell phone documenting his role in a scheme to fraudulently obtain unemployment insurance benefits should not be suppressed, a federal judge in Michigan ruled Oct. 29, finding that a private investigator for an insurance company was not acting as a government agent when viewing the contents of the phone (United States v. Damon Drekarr Kemp, No. 18-20043, E.D. Mich., 2018 U.S. Dist. LEXIS 184341).

  • October 25, 2018

    Magistrate Judge Denies Clinic’s Motion To Quash Insurer’s Subpoenas On Banks

    NEWARK, N.J. — An insurer accusing a medical clinic of submitting fraudulent no-fault insurance claims can subpoena two banks the clinic does business with for records pertaining to accounts it holds because the information is relevant, a federal magistrate judge in New Jersey ruled Oct. 23 in denying the clinic’s motion to quash (Government Employees Insurance Co., et al. v. Stefan Trnovski, M.D., et al., No. 16-4662, D. N.J., 2018 U.S. Dist. LEXIS 182375).

  • October 25, 2018

    9th Circuit Panel Upholds Convictions For Making False Statements To Grand Jury

    SAN FRANCISCO — A federal judge in California did not err when refusing to sever charges against two defendants accused of making false statements to a grand jury regarding their roles in a scheme to fraudulently obtain employment and disability insurance benefits, a Ninth Circuit U.S. Court of Appeals panel ruled Oct. 17, finding that the defendants were properly joined because the allegations stemmed from the same aspects of the alleged scheme and that there was sufficient evidence to support the convictions (United States v. Jasvir Kaur, et al., Nos. 17-10306, 17-10307, 9th Cir., 2018 U.S. App. LEXIS 29193).

  • October 25, 2018

    7th Circuit Upholds Dermatologist’s Conviction For Health Care Fraud

    CHICAGO — A Seventh Circuit U.S. Court of Appeals panel on Oct. 17 overruled a dermatologist’s arguments that his conviction on eight counts of health care fraud and eight counts of making false statements affecting a health care matter should be vacated, finding that the evidence presented by the government supported the jury’s decision and that improper remarks made by the prosecution during closing arguments did not taint the verdict (United States v. Omeed Memar, No. 17-3098, 7th Cir., 2018 U.S. App. LEXIS 29165).

  • October 24, 2018

    Judge Refuses To Dismiss Suit Over ‘Upcoding’ Of Services To Insurer

    PHILADELPHIA — A federal judge in Pennsylvania on Oct. 23 denied a motion to dismiss or transfer a lawsuit accusing a medical billing company of improperly upcoding services for neonatal intensive care to Aetna Inc. and its affiliates, finding that the insurer’s claims were timely and that its filing of a praecipe to issue a writ of summons in state court was sufficient to initiate action under the first-filed rule (Aetna Inc., et al. v. Mednax Inc., et al., No. 18-2217, E.D. Pa., 2018 U.S. Dist. LEXIS 181147).

  • October 17, 2018

    Judge Refuses To Reseal Documents In False Claims Act Suit Over Billing

    PHILADELPHIA — A federal judge in Pennsylvania on Oct. 16 refused to reconsider a Sept. 5 decision to lift the seal on documents in a suit brought under the qui tam provisions of the False Claims Act against an insurer accused of submitting fraudulent bills to Medicare and ordered the government to decide within 30 days if it will intervene in the suit (United States of America, ex rel. Jean Brasher v. Pentech Health Inc., No. 13-05745, E.D. Pa., 2018 U.S. Dist. LEXIS 177118).

  • October 17, 2018

    Judge: Failure To Identify Vicious Dog Constituted Material Misrepresentation

    RALEIGH, N.C. — A federal judge in North Carolina on Sept. 27 awarded summary judgment to an insurer, holding that a couple’s failure to disclose on their policy application that they owned an American Mastiff constituted a material misrepresentation that warranted the company’s refusal to provide coverage under a homeowner’s policy (United Property & Casualty Insurance Co. v. Jeffrey Surprenant, et al., No. 17-cv-96-FL, E.D. N.C., 2018 U.S. Dist. LEXIS 166240).

  • October 17, 2018

    Florida Doctor Charged With 26 Counts Of Health Care Fraud

    FORT PIERCE, Fla. — A Florida gynecologist and obstetrician was charged with 26 counts of health care fraud for allegedly billing Medicare for $926,802 in services that were not provided, according to an indictment filed Oct. 4 in Florida federal court (United States of America v. Sheetal Kanar Kumar, No. 18cr14063, S.D. Fla.).

  • October 16, 2018

    Clinic Operators Charged With Running $8.5M Health Care Fraud Scheme

    ATLANTA — The chief operating officer and the CEO of a medical clinic on Oct. 12 were charged in Georgia federal court with individual counts of conspiracy to commit health care fraud for their roles in a fraudulent billing scheme that resulted in private insurers paying $8.5 million for medical services that were never provided (United States of America v. Shailesh Kothari, et al., No. 18cr395, N.D. Ga.).

  • October 15, 2018

    Magistrate Judge Denies Nonparty’s Request To Stay Discovery In Fraud Suit

    DETROIT — A federal magistrate judge in Michigan on Oct. 12 denied a nonparty’s motion to stay discovery and for a protective order in an insurance fraud suit on grounds that the man has not been indicted and that the U.S. Department of Justice’s investigation into his involvement with the scheme does not overlap with State Farm Mutual Automobile Insurance Co.’s lawsuit against a number of physicians and medical clinics (State Farm Mutual Automobile Insurance Co. v. Elite Health Centers Inc., et al., No. 16cv13040, E.D. Mich., 2018 U.S. Dist. LEXIS 175603).

  • October 4, 2018

    Judge Refuses To Vacate Man’s Sentence For Staging Auto Accidents

    NEW YORK — A federal judge in New York on Oct. 3 denied a motion to vacate filed by a man who was sentenced to 10 years in prison for illegally staging automobile accidents and directing individuals to visit corrupt medical clinics, finding that he was unable to show that he received ineffective assistance of counsel before, during and after trial (Maxo Jean v. United States, No. 18 Civ. 2888, S.D. N.Y., 2018 U.S. Dist. LEXIS 171056).

  • October 3, 2018

    Judge Denies Man’s Request To Vacate Sentence For Unemployment Benefits Fraud

    DETROIT — A federal judge in Michigan on Sept. 26 refused to vacate a man’s 44-month prison sentence for fraudulently obtaining unemployment insurance benefits, finding that the court had jurisdiction over the allegations against him because he used the U.S. Postal Service to receive debit cards with the illegally obtained funds (United States of America v. Grady Whitaker Jr., No. 15-20388, E.D. Mich., 2018 U.S. Dist. LEXIS 165093).

  • October 1, 2018

    Judge Denies Man’s Motion For Acquittal, Finds Evidence Shows Involvement in Fires

    SOUTH BEND, Ind. — A federal judge in Indiana on Sept. 27 denied a man’s oral motion for acquittal raised during his trial on four counts of mail fraud, finding that the evidence presented by the government could lead a rational juror to believe that he had a role in starting two fires at his mobile home to deceive his insurance company (United States v. Michael Thomas, No. 18-cr-045 JD, N.D. Ind., 2018 U.S. Dist. LEXIS 166218).

  • October 1, 2018

    11th Circuit Finds No Clear Error In Judge’s Sentencing Of Pharmacy Owner

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Sept. 27 affirmed a pharmacy owner’s 48-month prison sentence after he pleaded guilty to one count of health care fraud, finding that a federal judge in Florida did not commit a clear error when applying the sophisticated means and manager/supervisor enhancements (United States v. Pedro Manuel Mangano, No. 18-10123, 11th Cir., 2018 U.S. App. LEXIS 27553).

  • September 25, 2018

    Litigation Privilege, Witness Immunity Doctrine Do Not Bar Insurer’s Fraud Claims

    LAS VEGAS — A federal judge in Nevada on Sept. 21 ruled that claims brought by Allstate Insurance Co. against two doctors and their practices for allegedly engaging in a scheme to inflate settlement values by creating false bills for patients who were injured as a result of automobile accidents are not barred by the litigation privilege and witness immunity doctrine, finding that the reports used as part of the scheme are not privileged (Allstate Insurance Co., et al. v. Marjorie Belsky, M.D., et al., No. 15cv2265, D. Nev., 2018 U.S. Dist. LEXIS 162318).