Mealey's Insurance Fraud
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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.
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February 15, 2022
Panel: Court Prematurely Granted Summary Judgment On ‘Thorny’ Materiality Questions
TRENTON, N.J. — A New Jersey appeals panel held on Feb. 14 that a lower court prematurely granted a business owner insurer’s motion for summary judgment on “thorny questions of materiality” in a dispute over an insurance claim for vandalism and theft, vacating and remanding for a jury to resolve the parties’ dispute over whether the insured made material misrepresentations in connection with its claims.
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February 11, 2022
Panel: Chiropractor Bills Supported Insured’s Felony Charge For Insurance Fraud
SALT LAKE CITY — A state trial court did not plainly err when it convicted a man of felony insurance fraud after he admitted to receiving chiropractic care after motor vehicle accidents even though he said he did not suffer any injuries warranting such treatment because state prosecutors provided sufficient evidence showing that the amounts billed to the man’s insurer by his chiropractor exceeded the threshold for a felony offense, a Utah Court of Appeals panel ruled Jan. 6 in affirming.
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February 11, 2022
Rehearing Sought In Relators’ Attorney Fee Dispute In FCA Qui Tam Actions
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. and several of its hospitals engaged in a fraudulent billing scheme against federal health insurance providers is necessary because a Sixth Circuit U.S. Court of Appeals panel erred in determining that neither the first-to-file bar nor the public disclosure bar were applicable in determining which relators were entitled to attorney fees, CHS argues in a Feb. 9 petition for rehearing and/or rehearing en banc filed in the federal appellate court.
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February 11, 2022
14th Former NFL Player Sentenced For Role In Health Care Fraud Scheme
LEXINGTON, Ky. — A former National Football League player on Feb. 9 was sentenced to five years in prison for his role in orchestrating a scheme to defraud the NFL’s health care benefit program.
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February 11, 2022
Excess Insurer’s Rescission Claim Withstands University’s Materiality Challenge
LOS ANGELES — A federal judge in California on Jan. 21 ruled that dismissal of an excess liability insurer’s rescission claim in a coverage dispute with the University of Southern California (USC) over allegations that the university failed to disclose allegations of sexual harassment and racial discrimination against a former employee is not warranted because the insurer has sufficiently shown that USC should have known that the allegations were material to the insurer’s decision to issue the policy.
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February 09, 2022
Georgia High Court Asked To Weigh In On Third-Party’s Viatical Policy Dispute
NEW ORLEANS — In what it determined is an issue of first impression, an 11th Circuit U.S. Court of Appeals panel on Feb. 4 certified two questions to the Georgia Supreme Court so that it may issue guidance concerning whether a third party with no insurable interest must be involved in the procurement of a life insurance policy before that policy can be deemed an unlawful human life wagering contract under Georgia law.
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February 09, 2022
Rescission Of Liability Policy Over Application Misstatements Upheld
SAN FRANCISCO — A federal district court did not err in granting an insurer’s motion for summary judgment in a lawsuit seeking rescission of a nonprofit organization liability insurance policy and declarations that the insurer had no duty to defend or indemnify a homeowners association or its property manager in lawsuits filed against them because the homeowners association made material misrepresentations in its insurance application, a Ninth Circuit U.S. Court of Appeals panel ruled on Feb. 7 in affirming.
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February 08, 2022
Insured’s Summary Judgment Bid Denied In Commercial Insurance Fraud Suit
DETROIT — An insurer has raised genuine issues of material fact as to whether the owners of a gas station committed insurance fraud when they allegedly burned down their gas station to collect the proceeds of a commercial insurance policy, a federal judge in Michigan ruled Feb. 3 in denying the insured’s summary judgment motion.
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February 08, 2022
Providers Prevail On Aetna’s Fraud Counterclaims, But Can’t Secure Sanctions
OKLAHOMA CITY — A federal judge in Oklahoma granted emergency care providers summary judgment on counterclaims alleging that a 36% upcoding rate constituted fraud but denied their motion alleging pretrial misconduct and seeking sanctions on Jan. 17.
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February 04, 2022
Panel Finds No Reversible Error In Court’s Dismissal Of Insurer’s Fraud Claims
HARRISBURG, Pa. — A Pennsylvania Superior Court panel on Feb. 1 ruled that a state trial court did not err in granting summary judgment in favor of medial providers and others on claims that the defendants engaged in a scheme to defraud insurer Liberty Mutual Group Inc. and several of its related entities and underwriters (collectively, Liberty Mutual) through a fraudulent compound pain cream prescription and kickback scheme because Liberty Mutual failed to sufficiently plead that the trial court committed any reversible errors in dismissing their fraud-based claims.
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February 02, 2022
Default Judgment Granted Over Contractor’s Insurance Application Misstatements
PITTSBURGH — A federal judge in Pennsylvania on Jan. 20 granted an insurer’s motion for default judgment in an insurance fraud dispute stemming from a contractor’s alleged material misrepresentations made in its application for insurance, ruling that the insurer has sufficiently pleaded that all necessary factors have been met in seeking such relief.
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January 31, 2022
Editor’s Note
The journalists and staff of Mealey’s Litigation Reports are saddened by the passing of co-founder Michael P. Mealey. He was a respected member of the newsletter community, being named publisher of the year by the National Newsletter Association and president of the National Newsletter Association. Mike and Judy Mealey started Mealey Publications Inc. in 1984. As president, Mike grew the Mealey’s Litigation Report portfolio, introduced email news bulletins and electronic CD formats and launched a continuing legal education conference business. Mealey’s was sold to LexisNexis in 2000. We hope to carry on his journalistic curiosity and integrity in the titles we continue to publish today under his name.
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January 21, 2022
Judge: 3 Of 4 Fraud Elements Of Disability Insurer’s Rescission Claim Pass Muster
FORT MYERS, Fla. — A federal judge in Florida on Jan. 11 substantially granted an insurer’s motion for summary judgment in a lawsuit seeking to rescind a doctor’s disability policy based on material misrepresentations the doctor made in his policy application, ruling that the insurer partially pleaded certain elements of its rescission claim.
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January 21, 2022
Partial Default Judgment Recommended In Insurer’s No-Fault Insurance Dispute
BROOKLYN, N.Y. — Government Employees Insurance Co. (GEICO) and certain of its related entities have sufficiently pleaded each of the elements of their common-law fraud claim against a physician and several of her New York- and New Jersey-based practices in a lawsuit alleging that the defendants fraudulently billed GEICO for claims under New York’s no-fault insurance statute for claims to which they were not entitled, a federal magistrate judge in New York ruled Jan. 19 in recommending that the insurer’s motion for default judgment be granted.
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January 20, 2022
Default Judgment Entered Against Nonresponsive Insured In Fraud Dispute
WILLIAMSPORT, Pa. — Default judgment is warranted against an insured in a lawsuit she brought against her homeowners insurer seeking to force the insurer to pay her claim for damages from a fire that destroyed her home because the insured failed to respond to the insurer’s motion for default judgment and the insurer has sufficiently stated its claim for insurance fraud, a federal judge in Pennsylvania ruled Jan. 12 in granting the motion.
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January 19, 2022
Insurer Had Reasonable Basis For Denying Claim For Insureds’ Fire Damages
OKLAHOMA CITY — An Oklahoma federal judge on Jan. 18 granted a homeowners insurer’s motion for summary judgment on a bad faith claim after determining that the insurer had a reasonable basis for denying the insureds’ claim for fire damages to their home based on the belief that the fire was intentionally set.
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January 18, 2022
Panel: Court Misinterpreted Policy In Ruling That Insured Misled Insurer
MIAMI — A Florida trial court erred in interpreting language in the concealment or fraud provision of a homeowners insurance policy in determining that an insured made fraudulent misrepresentations when she denied making similar past claims for insurance coverage because the insured’s post-loss “false statement” did not include “an element of intent to mislead,” a Third District Florida Court of Appeal panel ruled Jan. 12 in reversing.
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January 10, 2022
Magistrate Judge Recommends $1.6M RICO Damages Award In Fraudulent Billing Suit
BROOKLYN, N.Y. — A federal magistrate judge in New York on Dec. 16 recommended that a federal judge grant in part and denied in part a motion for default judgment sought by insurer Government Employees Insurance Co. (GEICO) and several of its related entities in a Racketeer Influenced and Corrupt Organizations Act (RICO) lawsuit stemming from an alleged fraudulent billing scheme, ruling that a default judgment totaling $1,645,107 against a doctor on the insurers’ RICO claim is warranted, but damages and interest on their common-law fraud claim is not.