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Mealey's Insurance Fraud

  • June 11, 2018

    Judge Denies General Practitioner’s Motion To Vacate Fraud Conviction

    SAN JOSE, Calif. — A federal judge in California on June 8 denied a general practitioner’s motion for acquittal on charges of health care fraud, finding that the spreadsheets and explanation of benefit (EOB) documents presented by the government constituted sufficient evidence showing that the doctor submitted fraudulent claims to insurance companies (United States v. Vilasini Ganesh, et al., No. 16cr00211, N.D. Calif., 2018 U.S. Dist. LEXIS 97028).

  • June 6, 2018

    Panel: Judge Erred When Modifying Plea Agreement For Lawyer Accused Of Fraud

    TRENTON, N.J.  — A New Jersey appeals court panel on June 5 reversed a judge’s decision to grant a request for pretrial intervention (PTI) from an attorney accused of insurance fraud, finding that the judge erred when vacating a different judge’s previous ruling denying the request (New Jersey v. Neal Pomper, No. A-3969-16T1, N.J. Super., App. Div., 2018 N.J. Super. Unpub. 1305).

  • June 5, 2018

    Pennsylvania Appeals Panel Affirms Woman’s Conviction For Arson, Insurance Fraud

    PITTSBURGH — A Pennsylvania appeals court panel on May 31 affirmed a woman’s conviction and 20- to 40-month sentence for insurance fraud and arson, finding that she received effective assistance of counsel (Pennsylvania v. Julia Ann Calipo, No. 1929 WDA 2016, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 1861).

  • June 4, 2018

    Judge Stays Coverage Suit Pending Insurer’s Liquidation Proceedings

    CHICAGO — An Illinois federal judge on June 1 stayed a coverage dispute between an insolvent Missouri insurer and an insured doctor regarding coverage provided under a professional liability insurance policy pending the duration of the liquidation proceedings (Galen Insurance Co. v. Vittorio Guerriero, M.D., et al., No. 15-06993, N.D. Ill., 2018 U.S. Dist. LEXIS 91393).

  • May 30, 2018

    Insurers Sufficiently Pleaded Fraud, RICO Claims Stemming From Scheme, Judge Rules

    MINNEAPOLIS — A federal judge in Minnesota on May 25 refused to dismiss a lawsuit brought by seven insurance companies accusing the owners of a number of chiropractic clinics of scheming to submit more than $1.8 million in fraudulent bills, finding that the companies’ fraud allegations satisfied the requirements of Federal Rule of Civil Procedure 9(b) and that the plaintiffs sufficiently stated claims under the Racketeer Influenced and Corrupt Organizations Act (Illinois Farmers Insurance Co., et al. v. Lake Street Chiropractic Clinic P.A., et al., No. 17-5090, D. Minn., 2018 U.S. Dist. LEXIS 87767).

  • May 30, 2018

    Panel Affirms Finding That Insurance Fraud Defendant’s Counsel Was Effective

    PHILADELPHIA — A Pennsylvania appeals panel on May 28 affirmed a trial court’s ruling denying a man’s request for relief under the Post Conviction Relief Act (PCRA) following his convictions for insurance fraud, corrupt organizations and identity theft, holding that the lower court judge did not err when finding that the man received effective assistance of counsel (Pennsylvania v. Michael David Ruth, No. 411 EDA 2017, Pa. Super., 2018 Pa. Super. LEXIS 1737).

  • May 25, 2018

    Surgery Center’s Consumer Fraud Counterclaim Against Insurers Dismissed By Judge

    CHICAGO — A surgery center failed to sufficiently state a claim against two insurance companies for violating the Illinois Consumer Fraud Act (ICFA), a federal judge in Illinois ruled May 24, holding that the insurers’ alleged misrepresentations to the center about whether its procedures were covered did not harm the patient population (Connecticut General Life Insurance Co., et al. v. Southwest Surgery Center LLC, No. 14-cv-8777, N.D. Ill., 2018 U.S. Dist. LEXIS 87551).

  • May 23, 2018

    2nd Circuit Upholds Sentence For ‘Brazen’ Employment Insurance Fraud Scheme

    NEW YORK — A Second Circuit U.S. Court of Appeals panel on May 21 upheld a federal judge in New York’s decision to sentence a man who pleaded guilty to fraudulently procuring $13,961 in unemployment insurance benefits from the New York Department of Labor while working as a correctional officer to six months in prison, holding that the judge sufficiently explained that the sentence was based on the brazen nature of the offense (United States v. Andrew Kessler, No. 17-2317-cr, 2nd Cir., 2018 U.S. App. LEXIS 13088).

  • May 21, 2018

    Judge Quashes Subpoenas Seeking Records Of All Of Doctor’s Toenail Avulsions

    NASHVILLE, Tenn. — A federal judge in Tennessee on May 18 quashed two subpoenas served on rehabilitation centers where a doctor who was found guilty of four counts of health care fraud performed toenail avulsions, finding that the requests were unduly burdensome and that they were not necessarily relevant for the calculation of the amount of loss incurred by Medicare and other insurers (United States v. John J. Cauthon, No. 15-cr-00172, M.D. Tenn., 2018 U.S. Dist. LEXIS 84104).

  • May 17, 2018

    California Panel Affirms Employment Restrictions For Insurance Fraud Defendant

    RIVERSIDE, Calif. — A California appeals court panel on May 10 found that a trial court judge did not err when finding that a man convicted of insurance fraud should not be allowed to hold a job in which he is required to use or control a bank account, finding that the probation restriction is intended to deter the defendant from future criminality (California v. Mario Tedoro Rios, No. D072430, Calif. App., 4th Dist., 1st Div., 2018 Calif. App. Unpub. LEXIS 3180).

  • May 15, 2018

    State Farm’s Fraud Suit Not Subject To Abstention, Preemption, Judge Rules

    FLINT, Mich. — State Farm Mutual Automobile Insurance Co.’s lawsuit accusing defendants of engaging in a scheme to submit fraudulent bills under its insureds’ no-fault insurance benefits coverage is not subject to abstention or preemption, a federal judge in Michigan ruled May 14 in denying the defendants’ motion to dismiss (State Farm Mutual Automobile Insurance Co. v. Vital Community Care PC, et al., No. 17-11721, E.D. Mich., 2018 U.S. Dist. LEXIS 80361).

  • May 14, 2018

    Judge Adopts Recommendation To Deny Fraud Defendant’s Motion To Vacate Sentence

    DALLAS — A federal judge in Texas on May 1 adopted a magistrate judge’s report and recommendation to deny a woman’s motion to vacate or set aside her 57-month prison sentence for health care fraud, holding that she received effective assistance of counsel and that the sentencing judge did not err when finding that her scheme resulted in more than $1.6 million in losses to Medicare (Brenda Ward v. United States, No. 16-cv-3128, N.D. Texas).

  • May 14, 2018

    Former Radiologist Pleads Guilty To Health Care Fraud, Prescribing Vicodin

    PITTSBURGH — A former radiologist at the University of Pittsburgh Medical Center (UPMC) on May 3 pleaded guilty to charges of health care fraud and unlawfully prescribing Vicodin, according to documents filed in Pennsylvania federal court (United States v. Marios Papachristou, No. 18-cr-0084, W.D. Pa.).

  • May 14, 2018

    Owner Of Mental Health Services Clinic Sentenced To 6 Years For Insurance Fraud

    HARRISBURG, Pa.  — A federal judge in Pennsylvania on May 9 sentenced the owner of a mental health services clinic to six years in prison and ordered her to pay $151,122.17 in restitution for billing Medicare for psychiatric services provided to the elderly and adolescents by unlicensed and untrained individuals (United States of America v. Joan Cicchiello, No. 15-cr-223, M.D. Pa.).

  • May 9, 2018

    California Panel Vacates Ruling Finding Officer’s Wife Guilty Of Insurance Fraud

    SAN DIEGO — A California appeals panel on May 8 vacated a woman’s conviction for her alleged role in her husband’s filing of a fraudulent insurance claim for the theft of his car, finding that the evidence did not sufficiently establish that she aided or abetted the scheme (California v. Robert Patrick Mejia, et al., No. D073113, Calif. App., 4th Dist., 1st Div., 2018 Cal. App. Unpub. LEXIS 3121).

  • May 7, 2018

    11th Circuit Upholds Man’s 90-Month Sentence For Insurance Fraud

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on May 3 affirmed a man’s 90-month sentence for conspiracy to commit health care fraud, holding that the judge properly applied an upward variance of 12 months based on the seriousness of the defendant’s conduct, as well as his criminal history (United States v. Yosbel Marimon, No. 17-13020, 11th Cir., 2018 U.S. App. LEXIS 11756).

  • May 2, 2018

    Appeals Court Vacates Insurance Fraud Conviction For Improper Jury Instruction

    RALEIGH, N.C. — A North Carolina appeals panel on May 1 vacated a woman’s convictions for insurance fraud and obtaining property by false pretense, holding that the language of the jury instructions was not similar to the language in the indictment (North Carolina v. Kelly Locklear, No. COA17-982, N.C. App., 2018 N.C. App. LEXIS 440).

  • April 27, 2018

    Panel Upholds Insurance Scam Conviction For Former Owner Of Insolvent Insurer

    RICHMOND, Va.  — A Fourth Circuit U.S. Court of Appeals panel on April 25 affirmed a federal judge in Maryland’s imposition of a 37-year prison sentence for the former owner of an insolvent insurer who pleaded guilty to wire fraud, aggravated identity theft, making false statements to insurance regulators and obstruction of justice, finding that an appeal waiver in his plea bargain barred most of his objections to the sentence (United States of America v. Jeffrey Brian Cohen, No. 15-4780, 4th Cir., 2018 U.S. App. LEXIS 10437).

  • April 24, 2018

    Kentucky Federal Judge Bars Opinions For Conflicting With Federal Regulations

    LEXINGTON, Ky. — A medical expert cannot testify for an ambulance company accused of Medicare fraud because his opinions contradict federal Medicare regulations and are impermissible legal conclusions, a Kentucky federal judge decided April 20 (United States of America v. Arrow-Med Ambulance, Inc., et al., No. 17-cr-73, E.D. Ky., 2018 U.S. Dist. LEXIS 66556).

  • April 24, 2018

    Government Can Introduce Evidence Of Scheme To Defraud, Judge Rules

    HONOLULU — The federal government can introduce evidence demonstrating that a speech therapist engaged in a scheme to defraud Tricare, a health care program for active military service members and their families, a federal judge in Hawaii ruled April 20, finding that the information is relevant to the charges against her (United States v. Sheila Harris, No. CR 17-00001, D. Hawaii, 2018 U.S. Dist. LEXIS 67360).