Mealey's Insurance Fraud
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March 24, 2022
Woman Seeks En Banc Rehearing In Arson, Insurance Fraud Conviction Appeal
ATLANTA — A woman convicted for her role in an alleged arson and insurance fraud scheme asked the 11th Circuit U.S. Court of Appeals on March 16 to rehear her appeal of a federal district court’s denial of her motion to stay pending a hearing regarding a restitution order entered against her, arguing that she has been unconstitutionally and unlawfully imprisoned because government prosecutors acted in bad faith by prosecuting her on a defective indictment.
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March 24, 2022
Insurer Seeks Summary Judgment In Fire Damage Claim Suit
EAST ST. LOUIS, Ill. — An insurer is entitled to summary judgment on its claims against its insured stemming from a landlord insurance claim the insured filed after two fires at property the insured owned because the policy is void based on material misrepresentations the insured made, as well as his failure to comply with conditions precedent, the insurer argues in a March 22 motion filed in Illinois federal court.
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March 22, 2022
6th Circuit Will Not Rehear Appeal In FCA Attorney Fees Case
CINCINNATI — In a one-paragraph order on March 18, a Sixth Circuit U.S. Court of Appeals panel ruled that it will not rehear a consolidated appeal brought by relators in five related qui tam lawsuits alleging that for-profit hospital and outpatient care center operator Community Health Systems Inc. (CHS) and several of its hospitals engaged in a fraudulent billing scheme against federal health insurance providers in violation of the False Claims Act (FCA).
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March 17, 2022
Florida Federal Judge Limits Billing, Coding Expert In Insurance Fraud Dispute
TAMPA, Fla. — A Florida federal judge on March 11 agreed to limit testimony from a coding and billing practices expert retained by a health care clinic and its personnel in a suit filed by its insurer seeking to recover $2.1 million for allegedly fraudulent no-fault insurance charges, finding that some of his opinions are inadmissible under Federal Rule of Evidence 702.
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March 16, 2022
4th Circuit Defines Objector’s Burden In Affirming Class Certification, Settlement
RICHMOND, Va. — Finding no abuse of discretion, a Fourth Circuit U.S. Court of Appeals panel on March 15 upheld a grant of class certification and settlement approval in a case over an alleged life insurance fraud scheme that shifted debt to reinsurers; the ruling also addressed that the court had “never clearly described who bears what burdens when a class member objects to a proposed settlement.”
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March 11, 2022
Clinic’s Summary Judgment Arguments In RICO Suit Lack Merit, Insurer Argues
TAMPA, Fla. — A health care clinic and its personnel are not entitled to summary judgment in a lawsuit filed by insurers seeking to recover $2.1 million from the defendants for allegedly submitting thousands of fraudulent no-fault insurance charges because none of their summary judgment arguments can withstand scrutiny, the insurers argue in a Feb. 3 opposition brief filed in Florida federal court.
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March 11, 2022
Business Owner’s Arson, Wire Fraud Conviction Affirmed By 4th Circuit Panel
RICHMOND, Va. — A federal district court did not err in denying an insured’s motion for judgment of acquittal in a criminal suit alleging that he aided and abetted another individual to set fire to the business he owned to collect on insurance proceeds because the evidence provided at trial was circumstantial in nature and was compelling enough for a jury to find that the man knowingly participated in the arson, a Fourth Circuit U.S. Court of Appeals panel ruled in affirming on Feb. 24.
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March 11, 2022
Insured’s Misrepresentations To Insurer Result In Summary Judgment Ruling
DELTA, Ark. — An insurer did not breach the terms of a homeowners insurance policy when it denied coverage to its insured for fire damage because no genuine issues of material fact exist disputing the insurer’s contention that the insured issued material misrepresentations in his application for insurance and during the claim investigation, a federal judge in Arkansas ruled March 7 in granting the insurer’s motion for summary judgment.
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March 11, 2022
Insured’s Concealment Of Marital Status Dooms Claims In ALE Coverage Dispute
NEW YORK — A federal judge in New York on Feb. 14 ruled that an insurer is entitled to summary judgment in a homeowners insurance dispute stemming from an insured’s attempt to receive additional living expenses (ALE) under two insurance policies for rent paid on a property owned by his wife because the insured materially misrepresented his marital status in seeking the benefits.
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March 11, 2022
Summary Judgment Ruling In Fire Damage Insurance Dispute Affirmed On Appeal
ST. LOUIS — A federal district court did not err in denying an insured’s summary judgment motion in an insurance coverage dispute stemming from a house fire because evidence showed that the insured materially misrepresented the value of the personal contents in the home before the fire, an Eighth Circuit U.S. Court of Appeals panel ruled Feb. 16 in affirming in part, reversing in part and remanding the action to the lower court.
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March 10, 2022
Claims Allowed To Proceed Against Medical Director In Fraudulent Billing Suit
TAMPA, Fla. — A federal judge in Florida on March 2 denied a motion to dismiss filed by a defendant in a fraudulent billing lawsuit, ruling that Government Employees Insurance Co. and several of its related entities have sufficiently pleaded claims for conspiracy under the Racketeer Influenced and Corrupt Organizations Act (RICO) and unjust enrichment to survive the motion.
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March 08, 2022
Law Firms’ Petitions In Attorney Fees Dispute Should Be Denied, Justices Told
WASHINGTON, D.C. — The U.S. Supreme Court should deny a pair of petitions filed by two law firms that jointly represented a pair of relators in a qui tam action and were denied attorney fees under the False Claims Act’s (FCA) first-to-file rule because the law firms’ petitions deal with nothing more than the denial of their attorney fees “in a case where the merits of the underlying claims are settled,” a group of health care companies and their owners argue in a March 4 opposition brief.
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March 03, 2022
Panel: No Errors In Jury Verdict, Trial Rulings In Long-Term Care Benefits Suit
SAN FRANCISCO — A federal district court in California was well within its discretion when it excluded an expert witness from testifying at trial in a long-term care insurance dispute stemming from an insured couple’s filing of allegedly fraudulent home health care claims, and a jury instruction it issued was not plainly erroneous, a Ninth Circuit U.S. Court of Appeal panel ruled March 1 in affirming a verdict against the couple.
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March 03, 2022
Judge Allows Deposition Testimony To Be Admitted In Fire Damage Suit
BANGOR, Maine — An insurer may admit deposition testimony from an insured’s employee even if he does not testify, and the employee’s invocation of his Fifth Amendment privilege against self-incrimination gives rise to an adverse inference against the insured in a marine insurance dispute stemming from the destruction of a fishing vessel that sustained fire damage, a federal judge in Maine ruled Feb. 28 in granting two motions in limine filed by the insurer in preparation for trial.
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March 02, 2022
11th Circuit Affirms Denial Of Stay Pending Hearing In Arson Scheme Appeal
NEW ORLEANS — A woman convicted for her role in an alleged arson and insurance fraud scheme has abandoned any argument that a federal district court erred in denying her motion to stay pending a hearing regarding a restitution order entered against her because she failed to challenge or address the grounds upon which the district court denied her motion in her appellate briefing, an 11th Circuit U.S. Court of Appeals panel ruled Feb. 28 in affirming.
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March 01, 2022
Panel Ruling In FCA Attorney Fees Case Does Not Warrant Rehearing, Relators Say
CINCINNATI — Rehearing of a consolidated appeal brought by relators in five related qui tam lawsuits alleging that for-profit hospital and outpatient care center operator Community Health Systems Inc. (CHS) and several of its hospitals engaged in a fraudulent billing scheme against federal health insurance providers is unwarranted because CHS fails to raise any persuasive arguments supporting such action, the relators argue in a Feb. 24 opposition brief filed in the Sixth Circuit U.S. Court of Appeals.
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February 25, 2022
Wisconsin Appellate Panel Sends Death Benefits Denial Suit Back To Trial Court
MILWAUKEE — A policyholder failed to set forth a prima facie showing that her insurer failed to comply with notice requirements under Wisconsin law when it denied life insurance benefits and sought to rescind two life insurance policies based on the policyholder’s alleged fraudulent misrepresentations in the procurement of the policies, a Wisconsin appellate panel ruled Feb. 22 in affirming in part and reversing in part.
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February 22, 2022
U.S. Supreme Court Declines Review Of Homeowners Insurance Fraud Dispute
WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 22 declined review of a divided Wisconsin Supreme Court’s ruling that a state appellate court did not err in granting summary judgment in favor of an insurer in an insurance dispute stemming from the insurer’s denial of homeowners insurance benefits pursuant to the policy’s concealment or fraud provision.
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February 22, 2022
Physician Group Guilty Of Submitting More Than 7,000 False Claims To Medicare
SAN ANTONIO — A federal jury in Texas on Feb. 16 found a physician group guilty of submitting 7,380 false billing claims, totaling more than $2.7 million in damages, to Medicare in a qui tam lawsuit brought by three former employees of the group.
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February 15, 2022
Recommendation Adopted In Insurer’s Fraudulent Billing Suit Against Physician
BROOKLYN, N.Y. — A federal judge in New York on Feb. 11 adopted a federal magistrate judge’s report recommending that an insurer be granted default judgment on its fraud and unjust enrichment claims in an insurance fraud dispute against a physician and several of her New York- and New Jersey-based practices over an alleged fraudulent billing scheme, finding no clear error in the uncontested portions of the report.