COLUMBIA, S.C. — A trial court judge in South Carolina did not err when admitting expert testimony from two investigators who responded to a fire caused by a woman to obtain insurance proceeds, a state appeals court panel ruled April 11, holding that they were qualified to proffer their opinions (State of South Carolina v. Paula Reed Rose, No. 2015-002445, S.C. App., 2018 S.C. App. LEXIS 24).
GULFPORT, Miss. — An expert for a man accused of making material misrepresentations to his insurance companies can provide testimony regarding industry standards between an agent and the insured, a federal judge in Mississippi ruled April 13, but the expert cannot proffer legal conclusions about those standards (American Zurich Insurance Co., et al. v. Curtis Guilbeaux, No. 16cv354-LG-RHW, S.D. Miss., 2018 U.S. Dist. LEXIS 62614).
LOS ANGELES — A bariatric surgery center likely knew that a bariatric surgeon relied on a subagent to receive insurance preauthorization for procedures and can therefore be liable for allegedly fraudulent representations, a federal judge in California held April 11 (Soma Surgery Center Inc. v. Aetna Life Insurance Co., et al., No. 16-5802, C.D. Calif.).
BILLINGS, Mont. — A federal judge in Montana on April 12 limited the testimony of two experts for a trucking company accused of insurance fraud for submitting claims for reimbursement following an explosion caused by its transport of natural gas condensate, holding that one expert could not discuss whether the explosion was the result of criminal activity and the other could not opine about the company’s state of mind (United States of America v. Woody’s Trucking LLC, et al., No. CR 17-138, D. Mont., 2018 U.S. Dist. LEXIS 62271).
HARRISBURG, Pa. — A Pennsylvania appeals panel on April 6 affirmed a trial court judge’s ruling sentencing a former psychologist to three to six years in prison for sexually assaulting two of his patients and submitting bills to their insurance companies for the treatments, finding that the judge properly relied on a presentence investigation (PSI) report when rendering his decision (Commonwealth of Pennsylvania v. Richard Scott Lenhart, No. 1070 MDA 2017, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 1099).
MINNEAPOLIS — The government presented sufficient evidence to prove that three individuals conspired to illegally refer automobile accident victims to a chiropractic clinic that submitted bills to insurance companies for medically unnecessary treatments because misrepresentations they made to the companies were material and intended to defraud them, a federal judge in Minnesota ruled April 5 in denying their motions for acquittal (United States of America v. Preston Ellard Forthun, et al., No. 16-339, D. Minn., 2018 U.S. Dist. LEXIS 58214).
NEWARK, N.J. — A federal judge in New Jersey on April 5 entered default judgment against a doctor accused of participating in a scheme to submit fraudulent bills to Government Employees Insurance Co. (GEICO) for treating patients allegedly injured in automobile accidents and ordered him to pay $7.3 million, finding that the insurer sufficiently stated claims against the physician for fraud, unjust enrichment and violation of the New Jersey Insurance Fraud Prevention Act (IFPA) (Government Employee Insurance Co. v. Lyudmila Poretskaya, M.D., et al., No. 16-08448, D. N.J., 2018 U.S. Dist. LEXIS 58102).
CHICAGO — A federal judge in Wisconsin erred when finding how much of a couple’s property the government could seek in restitution after the husband was sentenced for committing insurance fraud, a Seventh Circuit U.S. Court of Appeals panel ruled March 28, finding that the judge should have considered only the couple’s financial situation at the time the restitution judgment was entered rather than when the defendant was resentenced in April 2015 (United States of America v. John E. Henricks III, No. 17-2383, 7th Cir., 2018 U.S. App. LEXIS 7596).
LONDON, Ky. — A federal judge in Kentucky on March 25 barred an expert from testifying about the national average of pacemakers that were implanted in patients from 2012 to 2014 on behalf of a doctor accused of defrauding Medicare by implanting pacemakers in patients who did not need them, finding that the expert’s disclosure was untimely (United States of America v. Anis Chalhoub M.D., No. 16-cr-00023-GFHT-HAI, E.D. Ky.,2018 U.S. Dist. LEXIS 49775).
PASADENA, Calif. — A federal judge in California did not err when ordering a woman who pleaded guilty to health care fraud to pay $4 million in restitution, a Ninth Circuit U.S. Court of Appeals panel ruled March 23, finding that the judge did not err when calculating the amount of loss (United States of America v. L’Tanya Denise Smith, No. 16-50322, 9th Cir., 2018 U.S. App. LEXIS 7411).
SAN FRANCISCO — An insurer did not act in bad faith in its handling of an automobile insurance claim because “substantial evidence” uncovered in the insurer’s claim investigation outweighed an insured’s assertions regarding the alleged theft of her vehicle, a federal judge in California ruled March 16 in granting the insurer’s summary judgment motion (Kevineshia Island v. State Farm Fire and Casualty Co., et al., No. 16-5449, N.D. Calif., 2018 U.S. Dist. LEXIS 44737).
MINNEAPOLIS — A federal judge in Minnesota on March 12 denied a man’s motion to dismiss a superseding indictment charging him with conspiracy to commit health care fraud, finding that the allegations in the indictment adequately alleged that he was a runner who recruited patients to go to a chiropractic clinic that submitted fraudulent claims to insurance companies (United States v. Angela April Schulz, et al., No. 16-341, D. Minn., 2018 U.S. Dist. LEXIS 41145).
TRENTON, N.J. — A federal judge in New Jersey on March 9 entered default judgment against a radiology clinic and four of its owners who are accused of submitting fraudulent bills to the Government Employees Insurance Co. (GEICO) for reimbursement under patients’ no-fault personal injury protection (PIP) and ordered them to pay $2.3 million, finding that the defendants failed to raise at litigable defense (Government Employees Insurance Co., et al. v. Hamilton Health Care Center PC., et al., No. 17-0674, D. N.J., 2018 U.S. Dist. LEXIS 38902).
FORT PIERCE, Fla.— A federal judge in Florida on March 7 dismissed a lawsuit accusing a dermatologist of violating the False Claims Act when billing Medicare and TRICARE, which provides health benefits for U.S. Armed Forces personnel, for muscle flap procedures that were not performed after the doctor agreed to pay $2.5 million to resolve the allegations (United States, ex rel. Patricia Cleary v. Tim Ioannides, M.D., et al., No. 15-14306, S.D. Fla.).
NEW YORK— A federal judge in New York on March 6 denied a woman’s motion to vacate her sentence for conspiracy to commit insurance fraud, finding that she lacked standing because she was not “in custody” at the time she filed her motion (Seritta Klass v. United States of America, No. 11 cr 893, S.D. N.Y., 2018 U.S. Dist. LEXIS 36511).
WEST PALM BEACH, Fla. — A federal judge in Florida on Feb. 21 found that a doctor’s fraudulent billing scheme resulted in Medicare losing more than $73.4 million, warranting an enhancement of his sentence (United States of America v. Salomon E. Melgen, No. 15-80049-CR-MARRA, S.D. Fla., 2018 U.S. Dist. LEXIS 31012).
GEORGETOWN, Del. — A man who pleaded guilty to submitting a fraudulent insurance claim must pay $225,639.70 in restitution to the insurance company, a Delaware judge ruled Feb. 21, finding that a payment plan can be implemented to accommodate his alleged inability to pay (Delaware v. Robert S. Bangs, No. 1702000830, Del. Super., Sussex Co., 2018 Del. 88).
CINCINNATI — A home health care provider’s former director of nursing may proceed with her claims that she was forced to resign due to her employer’s decision to seek and receive fraudulent reimbursements from the federal government as a jury may determine that the employer’s alleged fraud “plus the employee’s moral conscience and reasonable fear of being accused of participating in the employer’s fraud is enough to justify quitting,” a Sixth Circuit U.S. Court of Appeals panel ruled March 2 (Sue Smith v. LHC Group, Inc., et al., No. 17-5850, 6th Cir., 2018 U.S. App. LEXIS 5345).
PHILADELPHIA — A Pennsylvania appeals court on Feb. 27 affirmed a man’s conviction for arson and insurance fraud, finding that the trial court judge did not err in admitting evidence from two fires that occurred in March 2011, as well as testimony from the fire chief in which he concluded that the cause of the fire was an incendiary device (Pennsylvania v. John Edward Chairmonte, No. 2815 EDA 2015, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 590).
LOS ANGELES — Medical service providers accused by UnitedHealth Group Inc. of submitting fraudulent bills were ordered by a federal magistrate judge in California on March 2 to provide responsive documents that are contained in a database, finding that the company that has the software license for the database is an alter ego of the providers (Almont Ambulatory Surgery Center LLC, et al. v. UnitedHealth Group Inc., et al., No. CV 14-03053-MWF, C.D. Calif., 2018 U.S. Dist. LEXIS 35616).