Mealey's Insurance Fraud
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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).
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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).
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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).
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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).
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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.).
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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.).
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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).
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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).
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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).
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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).
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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).
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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).
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April 24, 2018
Colorado Attorney Disbarred For Fraudulent Receipt Of Unemployment Benefits
DENVER — An attorney in Colorado was disbarred by the state high court’s presiding disciplinary judge on April 10 after she submitted false claims to receive unemployment benefits while she was employed (Colorado v. April Renee Morrissette, No. 17PDJ033, Colo. Sup., 2018 Colo. Discpl. LEXIS 29).
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April 19, 2018
Appeals Panel Says Judge Properly Allowed Evidence Of Accidents Outside Indictment
RALEIGH, N.C. — A trial court judge did not err when allowing evidence related to automobile accidents that a man was involved in that were not listed in his indictment for insurance fraud and other charges, a North Carolina appeals court ruled April 17, finding that the information was directly related to the charges against him (North Carolina v. Byron Benson Fulghum Jr., No. COA17-334, N.C. App., 2018 N.C. App. LEXIS 390).
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April 19, 2018
Nevada High Court Upholds Woman’s Sentence For Arson, Insurance Fraud
CARSON CITY, Nev. — The Nevada Supreme Court on April 10 affirmed a woman’s sentence after she pleaded guilty to charges of first-degree arson and insurance fraud, finding that her counsel was effective when representing her (Ria Eunhye Lee v. Nevada, No. 72653, Nev. Sup., 2018 Nev. Unpub. LEXIS 296).
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April 19, 2018
Judge: Insurer Showed Basis For Denying Claim Stemming From Fire Loss
JOHNSTOWN, Pa. — A federal judge in Pennsylvania on April 11 awarded summary judgment to an insurer accused of bad faith when denying a man’s $1 million claim for losses incurred following a fire at his home, finding that the evidence on the record demonstrates that the company conducted a reasonable investigation into whether the man actually lost a pair of 1.5 carat diamond earrings and a Louis Vuitton purse in the blaze (American National Property and Casualty Company v. Daniel J. Felix, No. 16-cv-147, W.D. Pa., 2018 U.S. Dist. LEXIS 61020).
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April 18, 2018
Panel Finds Judge Properly Admitted Experts’ Testimony On Fire’s Cause
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).
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April 17, 2018
Judge Limits Attorney’s Expert Testimony To Insurance Industry Standards
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).
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April 16, 2018
Surgery Center Has Liability For Subagent’s Conduct With Insurer, Judge Says
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.).
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April 16, 2018
Judge Limits Testimony Of Trucking Company’s Experts In Fraud Suit
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).