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Mealey's Insurance Fraud

  • June 29, 2018

    11th Circuit Upholds Man’s 27-Month Sentence For False Health Care Statements

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on June 27 ruled that a federal judge in Georgia did not err when sentencing a Veterans Administration (VA) clinic’s former chief of the fee division to 27 months in prison for 50 counts of making false statements in connection with the delivery of, or payment for, health care services and one count of making a materially false statement to a federal agent, finding that the evidence presented by the government was sufficient and that the trial court judge did not err when imposing the sentence (United States of America v. Cathedral Henderson, No. 16-16984, 11th Cir., 2018 U.S. App. LEXIS 17634).

  • June 29, 2018

    Misrepresentations On Loss Of Personal Belongings After Fire Were Material

    MINNEAPOLIS — A federal judge in Minnesota on June 26 denied a family’s motion for judgment as a matter of law, finding that State Farm Fire and Casualty Co. sufficiently showed during trial that the insureds made material misrepresentations about items that were lost in a fire (Todd Borchardt, et al. v. State Farm Fire and Casualty Co., No. 16-CV-0055, D. Minn., 2018 U.S. Dist. LEXIS 107355).

  • June 27, 2018

    Criminal Investigation Of Doctors, Clinic, Does Not Warrant Staying Depositions

    NEW YORK — A criminal investigation by the New York Attorney General’s Office to the billing practices of doctors and two clinics accused by State Farm Mutual Automobile Insurance Co. of submitting fraudulent claims and medical records does not warrant staying the defendants’ depositions, a federal magistrate judge in New York ruled June 25, noting that there hasn’t been any activity in the investigation for nearly a year (State Farm Mutual Automobile Insurance Co. v. Brij Mittal, M.D., et al., No. 16-CV-4948, E.D. N.Y., 2018 U.S. Dist. LEXIS 106100).

  • June 26, 2018

    Doctors Accused Of Inflating Bills Can Face Insurer’s Lawsuit, Judge Says

    LAS VEGAS — A number of doctors accused of fraudulently inflating bills that were submitted to Allstate Insurance Co. and its subsidiaries so patients could attempt to extract more money from the company in personal injury lawsuits can face a lawsuit filed by the insurer, a federal judge in Nevada ruled June 18, finding that the claims are not barred by the Nevada litigation privilege or federal witness immunity (Allstate Insurance Co., et al. v. Russell J. Shah, M.D., et al., No. 15-cv-01786, D. Nev., 2018 U.S. Dist. LEXIS 101952).

  • June 25, 2018

    Kentucky Appeals Court Upholds Revocation Of Fraud Defendant’s Probation

    FRANKFORT, Ky. — A Kentucky appeals court panel on June 22 upheld a trial judge’s ruling revoking probation for a man who pleaded guilty to insurance fraud, holding that the defendant’s probation violations resulted in a threat to the community (Richard N. Thompson v. Kentucky, Nos. 2015-CA-001938, Ky. App., 2018 Ky. App. Unpub. LEXIS 434).

  • June 21, 2018

    Judge Finds Service On Niece Of Doctor Accused Of Fraud Sufficient

    ANN ARBOR, Mich. — A federal judge in Michigan on June 19 denied a doctor’s motion to dismiss a lawsuit brought by Allstate Insurance Co. accusing him and his practice of submitting fraudulent claims, finding that service of the complaint to his niece was sufficient to establish that he lived there (Allstate Insurance Co., et al. v. Utica Physical Therapy Inc., et al., No. 17-cv-13823, E.D. Mich., 2018 U.S. Dist. LEXIS 101764).

  • June 20, 2018

    Judge Adopts Recommendation To Revoke Fraud Defendant’s Supervised Release

    COVINGTON, Ky. — A federal judge in Kentucky on June 19 adopted a magistrate judge’s June 15 recommendation to order a man who pleaded guilty to three counts of aiding and abetting insurance fraud to serve 14 months in prison for violating the conditions of his supervised release (United States of America v. Roben Casey Bykovny, No. 15-36-DLB-CJS-7, E.D. Ky.).

  • June 18, 2018

    11th Circuit: Evidence Supported Convictions For Arson Scheme

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on June 14 affirmed rulings by a federal judge in Georgia denying two defendants’ motions for acquittal, holding that the evidence presented by the government sufficiently showed that they conspired and committed mail fraud as part of a scheme to submit fraudulent insurance claims after setting homes on fire (United States v. Shirley Denise Burk, et al., No. 16-14248, 11th Cir., 2018 U.S. App. LEXIS  15979).

  • June 13, 2018

    Panel: Trial Court Must Recalculate Restitution For Insurer’s Investigation

    RIVERSIDE, Calif. — An appeals court panel in California on May 31 vacated a trial court judge’s ruling ordering a woman who pleaded guilty to one count of making a false statement in support of an insurance claim to pay $1,042.17 in restitution to an insurance company, finding that the company did not take into account the costs it incurred as a result of its investigation of the defendant’s claim (People of California v. Alyce J. Williams, No. D072783, Calif. App., 4th Dist., 1st Div., 2018 Cal. App. Unpub. LEXIS 3728).

  • June 13, 2018

    Opioid Addiction Treatment Center Owner Indicted For Insurance Fraud

    PITTSBURGH — The owner of an opioid addiction treatment center was indicted in Pennsylvania federal court June 5 on charges of health care fraud, conspiracy to unlawfully distribute a controlled substance, and aiding and abetting the unlawful distribution of a controlled substance for allegedly dispensing buprenorphine, a drug used to treat addiction, and submitting fraudulent claims to Medicare and Medicaid for the drug (United States v. Jennifer Hess, No. 18cr142, W.D. Pa.).

  • June 13, 2018

    Divided 6th Circuit Reverses Dismissal Of Suit Over Senior Center’s Billing

    CINCINNATI — A woman’s False Claims Act (FCA) lawsuit accusing a senior living center of failing to submit to Medicare certifications supporting the need for medical services for patients was reinstated June 11 by a 2-1 Sixth Circuit U.S. Court of Appeals panel, after it found that the woman’s allegations satisfied the act’s requirements for materiality and scienter (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir., 2018 U.S. App. LEXIS 15617).

  • June 13, 2018

    Farmers Indicted On False Claims For Reinsured Crop Insurance Program

    LEXINGTON, Ky. — Farmers defrauded the United States through the filing of false insurance claims reimbursed by the U.S. Department of Agriculture (USDA) and by making false statements and reports in connection with the federally reinsured crop insurance program, the government alleges in a June 6 indictment filed in a Kentucky federal court (United States v. Bradley Price, et al., No. 18-cr-60, E.D. Ky.).

  • 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).