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Mealey's Insurance Fraud

  • August 13, 2018

    Woman Withdraws Not Guilty Plea To Health Care Fraud

    BENTON, Ill. — An Illinois woman on Aug. 10 pleaded guilty to one felony count of health care fraud in Illinois federal court after withdrawing her earlier plea of not guilty (United States of America v. Betsy Gutowski, No. 17cr40046, S.D. Ill.).

  • August 8, 2018

    Judge Vacates Entry Of Default Against Doctor, Clinic Accused Of Fraud

    CAMDEN, N.J. — A federal judge in New Jersey on Aug. 6 vacated an entry of default against a doctor and a clinic accused of submitting fraudulent bills to the Government Employees Insurance Co. (GEICO), finding that the defendants raised meritorious defenses to the insurer’s allegations and that the company’s complaint contained “shotgun pleadings” (Government Employees Insurance Co. v. Pennsauken Spine & Rehab PC, et al., No. 17-11727, D. N.J., 2018 U.S. Dist. LEXIS 131529).

  • August 6, 2018

    Appeals Panel Upholds Woman’s Insurance Fraud Conviction, Tosses Failure To Appear

    SACRAMENTO, Calif. — A California appeals panel on Aug. 1 affirmed a woman’s conviction on three counts of insurance fraud, holding that evidence presented during the trial sufficiently showed that she was not a passenger in a vehicle when it was struck by another vehicle (People of the State of California v. Deborah Carter, No. C083541, C084717, Calif. App., 3rd Dist., 2018 Cal. App. Unpub. LEXIS 5269).

  • August 2, 2018

    Home Care Services Company, Operators Ordered To Pay $2.9M Over False Billing

    RALEIGH, N.C. — A federal judge in North Carolina on July 30 ordered a home health care services company and its operators to pay $2.9 million for violating the federal and North Carolina false claims acts when submitting fraudulent bills for services that were provided in violation of Medicare policies or not provided at all and falsifying documents to conceal the fraud (United States, et al. v. Compassionate Home Care Services Inc., et al., No. 14-CV-113-D, E.D. N.C.).

  • August 1, 2018

    Federal Jury Convicts Sleep Study Clinic Owner For Health Care Fraud

    ALEXANDRIA, Va.— A jury in Virginia federal court on July 30 convicted the former owner of a sleep study clinic on one count of conspiracy to commit health care fraud and wire fraud, one count of conspiracy to defraud the United States, one count of filing a false tax return and seven counts of health care fraud (United States of America v. Young Yi, et al., No. 17cr224, E.D. Va.)

  • July 31, 2018

    Judge Adjusts Man’s Sentence For Unemployment Benefits Fraud Charges

    MILWAUKEE — A federal judge in Wisconsin on July 27 amended a man’s sentenced for wire fraud and aggravated identity theft as part of a scheme to fraudulently obtain unemployment insurance benefits, finding that his appellate counsel acted deficiently when failing to argue that his sentence should be adjusted to reflect for time he served in state prison (Calvin V. Sanders v. United States of America, No. 18-cv-919, E.D. Wis., 2018 U.S. Dist. LEXIS 125657).

  • July 26, 2018

    Evidence Supported Restitution Amount Ordered In Disability Fraud Suit, Panel Says

    SACRAMENTO, Calif. — A trial court judge did not abuse his discretion when ordering a man to repay $5,502 to his employer for temporary disability benefits he unlawfully received, a California appeals court panel ruled July 24, finding that the evidence presented by the state sufficiently supported the amount (People of the State of California v. Michael William Williams, No. C086000, Calif. App., 3rd Dist., 2018 Cal. App. Unpub. LEXIS 5057).

  • July 23, 2018

    Magistrate Recommends Accepting Guilty Pleas For Health Care Fraud

    TAMPA, Fla. — A federal magistrate judge in Florida on July 20 recommended accepting a woman’s guilty pleas to two counts of health care fraud, finding that she is knowledgeable about the offenses for which she is charged (United States of America v. Lisa McLaren Janick, No. 17cr502, M.D. Fla.).

  • July 19, 2018

    6th Circuit Allows Amicus Briefs Seeking Rehearing Of Medicare Billing Case

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on July 16 granted requests from the Washington Legal Foundation (WLF) and National Association for Home Care & Hospice Inc. (NAHCH) to submit amicus curiae briefs in support of a nursing home facility’s request for an en banc hearing as to whether a former worker sufficiently alleged that the company made material misrepresentations under the False Claims Act (FCA) when failing to timely submit physician certification to support treatment provided to patients (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir.).

  • July 19, 2018

    Ambulance Company To Pay $16,776 For Submitting False Claims

    BANGOR, Maine — An ambulance company has agreed to pay the federal government and state of Maine $16,776.74 to resolve claims that it submitted false bills to Medicare and Maine’s Medicaid program, MaineCare, from January 2015 through April 2016 to pay the salary of an employee who had previously been excluded from participating in federal and state health care programs, according to a notice of settlement filed July 17 in Maine federal court (United States v. County Ambulance Service Inc., No. 18-cv-280, D. Maine).

  • July 18, 2018

    Ohio Panel Vacates Nationwide’s Summary Judgment Ruling Over Misrepresentation

    YOUNGSTOWN, Ohio — An Ohio appeals panel on June 29 overturned a ruling awarding summary judgment to Nationwide Mutual Fire Insurance Co., finding that the company’s policy application did not specifically state that a misrepresentation would void the policy (Nationwide Mutual Fire Insurance Co. v. Barbara Pusser, et al., No. 17 MA 0117, Ohio App., 7th Dist., 2018 Ohio App. LEXIS 2988).

  • July 18, 2018

    Nevada Appeals Court Majority Says Man Should Be Resentenced For Fraud

    LAS VEGAS — A man who was convicted on two felony counts of insurance fraud should be resentenced, a 2-1 Nevada Court of Appeals ruled June 22, finding that the state failed to present sufficient evidence showing that the value of items the defendant attempted to obtain proceeds from exceeded $650 (Tarek Diab Gohar v. Nevada, No. 73872, Nev. App., 2018 Nev. App. Unpub. LEXIS 511).

  • July 17, 2018

    California Panel Affirms Restitution Amount For Unemployment Benefits Fraud

    SAN FRANCISCO — A California appeals court panel on July 16 affirmed a trial court’s ruling requiring a flower shop owner to pay $14,200 in restitution to a former employee after she pleaded no contest to fraud charges stemming from her failure to pay for unemployment and workers’ compensation insurance, finding that while the former employee’s work records “were a mess,” the trial judge properly calculated the amount needed to make the victim whole (People of California v. Cynthia Ann Smith, No. A153490, Calif. App., 1st Dist., 5th Div., 2018 Cal. App. Unpub. LEXIS 4769).

  • July 17, 2018

    Bank For Clinic Accused Of Fraud Must Produce Records, Magistrate Says

    TAMPA, Fla. — A health care clinic and doctor accused of submitting fraudulent medical bills for automobile accident victims to the Government Employees Insurance Co. (GEICO) failed to have a subpoena served on their bank quashed after a federal magistrate judge in Florida ruled July 16 that the records were relevant and not protected from disclosure (Government Employees Insurance Company v. Analgesic Healthcare Inc., et al., No. 17-cv-1130-T-27AAS, M.D. Fla., 2018 U.S. Dist. LEXIS 117887).

  • July 12, 2018

    Magistrate: ‘Serial Fraudster’ Should Remain Detained Due To Flight Risk

    WEST PALM BEACH, Fla.  — The owner of a sober house accused of health care fraud for running a scheme involving the submission of bills to insurers for medically unnecessary drug screening tests should remain detained pursuant to the Bail Reform Act of 1984 because he is a “serial fraudster and an economic danger to the community,” a federal magistrate judge in Florida ruled July 6 (United States v. Kenneth Bailynson, et al., No. 18-cr-80124, S.D. Fla., 2018 U.S. Dist. LEXIS 113820).

  • July 12, 2018

    Doctor’s Indictment Adequately Alleges Claim For Health Care Fraud, Judge Rules

    LONDON, Ky. — A federal judge in Kentucky on July 3 denied a doctor’s motion to dismiss a charge of health care fraud from his indictment, finding that the allegations are sufficient to put the doctor on notice of the claims against which he must defend (United States v. Ezekiel Akande, M.D., No. 17-cr-0013-GFVT-HAI, E.D. Ky., 2018 U.S. Dist. LEXIS 111593).

  • July 10, 2018

    1st Circuit: Juror’s Use Of Dictionary Does Not Warrant New Fraud Trial

    BOSTON— A First Circuit U.S. Court of Appeals panel ruled July 9 that while a federal judge in Puerto Rico abused his discretion when granting a juror’s oral request for a dictionary to look up the word “knowingly” during deliberations of a mail fraud trial against a doctor, the error was not prejudicial enough to warrant a new trial for the defendant (United States v. Anibal Pagan-Romano, No. 16-1396, 1st Cir., 2018 U.S. App. LEXIS 18594).

  • July 10, 2018

    Judge: Contract Claims In Suit Over Crop Insurance Fraud Subject To Arbitration

    MINNEAPOLIS— A federal judge in Minnesota on July 6 dismissed two breach of contract claims from a man’s False Claims Act (FCA) lawsuit accusing six farm owners of illegally obtaining crop insurance proceeds, finding that the causes of action are subject to arbitration pursuant to a partnership agreement between the parties (United States, ex rel. Kenneth Kraemer, et al. v. United Dairies LLP, et al., No. 16-3092, D. Minn., 2018 U.S. Dist. LEXIS 112305).

  • July 10, 2018

    Doctor’s 68-Month Prison Sentence For Fraud Upheld By 6th Circuit

    CINCINNATI — A federal judge in Michigan did not abuse his discretion when resentencing a doctor convicted of health care fraud conspiracy, conspiracy to pay health care kickbacks and conspiracy to distribute a controlled substance to 68 months in prison, a Sixth Circuit U.S. Court of Appeals panel ruled June 25, holding that the judge sufficiently explained the starting point for the sentence and asked the defendant and his counsel if they read the presentence report (United States v. Carl Fowler, M.D., No. 17-1100, 6th Cir., 2018 U.S. App. LEXIS 17370).

  • July 2, 2018

    Magistrate Judge Agrees To Strike Some Portions of Fire Loss Indictment

    SOUTH BEND, Ind. — A federal magistrate judge in Indiana on June 29 agreed to strike two paragraphs from a man’s indictment on four counts of mail fraud stemming from an alleged scheme to intentionally set fires to homes he owned to collect insurance proceeds, finding that the information in the paragraphs was unnecessary (United States of America v. Michael Thomas, No. 18-CR-00045 JD, N.D. Ind., 2018 U.S. Dist. LEXIS 108983).