Mealey's Insurance Fraud
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January 10, 2022
Michigan Supreme Court Declines To Weigh In On No-Fault Insurance Appeal
LANSING, Mich. —The Michigan Supreme Court on Nov. 29 denied an insured’s application for leave to appeal a state appellate panel’s ruling overturning a trial court’s denial of an insurer’s motion for summary judgment in a no-fault automobile insurance dispute stemming from the insurer’s denial of coverage to a claimant based on alleged material misrepresentations its insured made in her application for insurance.
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January 10, 2022
Justices Asked To Cure Circuit Split Over Particularity Application In FCA Suits
WASHINGTON, D.C. — The U.S. Supreme Court should grant review of a Sixth Circuit U.S. Court of Appeals’ ruling affirming the dismissal of False Claims Act (FCA) and related state law claims brought in a qui tam action against a home health agency and others to cure a circuit split regarding how the particularity standard set forth in Federal Rule of Civil Procedure 9(b) is applied to FCA cases, the relator argues in a Dec. 21 petition for a writ of certiorari.
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January 10, 2022
Law Firm Asks High Court To Hear Appeal Of Attorney Fees Denial In FCA Lawsuit
WASHINGTON, D.C. — A Fifth Circuit U.S. Court of Appeals panel erred when it affirmed a federal district court’s dismissal of a qui tam action stating claims under, inter alia, the False Claims Act (FCA) and the Texas Medicaid Fraud Prevention Act (TMFPA) and denial of relators’ request for attorney fees because the appellate court misapplied the federal statute’s first-to-file bar, counsel for the relators argues in a Nov. 24 petition for a writ of certiorari filed in the U.S. Supreme Court.
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January 07, 2022
Insured’s Misrepresentation Allowed Insurer To Rescind Policy, Judge Rules
DETROIT — An insurer was entitled to rescind its insurer’s homeowners insurance policy after discovering that the insured had materially misrepresented in her application for insurance that the property taxes on her home were current at the time she purchased it by quitclaim deed, a federal judge in Michigan ruled Dec. 14 in granting the insurer’s motion for summary judgment on the insured’s breach of contract claim.
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January 05, 2022
Dismissal Of Relator’s FCA Claims Against Former Employer Overturned On Appeal
CHICAGO — A federal district court erred in dismissing a relator’s False Claims Act (FCA) claims against his former employer in a qui tam lawsuit stemming from the employer’s alleged upcoding for anesthesia services that were not provided to Medicare and Medicaid patients because the relator provided sufficient examples of the alleged scheme in an amended complaint that satisfied the statutorily required heightened pleading standards for fraud claims, as required, a Seventh Circuit U.S. Court of Appeals panel ruled Dec. 8 in reversing and remanding.
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December 23, 2021
Judge Issues Judgment In Favor Of Insurer In Fire Damage Coverage Dispute
CAMDEN, N.J. — In a one-page order, a federal judge in New Jersey on Dec. 20 issued a judgment in favor of an insurer in a homeowners insurance dispute stemming from the insurer’s denial of its insureds’ claim for fire losses based on alleged material misrepresentations the insureds made in their claim.
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December 22, 2021
Magistrate Judge Recommends Default Judgment Be Granted In Insurance Fraud Suit
BROOKLYN, N.Y. — Default judgment against three individuals who are alleged to have defrauded Government Employees Insurance Co. (GEICO) and several of its related entities as part of a Racketeer Influenced and Corrupt Organizations Act (RICO) scheme is warranted because GEICO has sufficiently pleaded both liability for common-law fraud and fraud damages against the defendants, a federal magistrate judge ruled Dec. 17 in issuing a report and recommendation that the motion be granted.
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December 21, 2021
2nd Circuit Panel Upholds Dismissal Of Claims In STOLI Fraud Suit
NEW YORK — New York’s choice-of-law provision precludes an insurer from obtaining damages under New Jersey’s insurance fraud statute in a stranger-owned life insurance policy (STOLI) dispute, and a district court did not err in denying certain of the insurer’s counterclaims against a claimant because the insurer failed to sufficiently show that the claimant had any knowledge that the policy was fraudulently obtained, a Second Circuit U.S. Court of Appeals panel ruled Dec. 17 in affirming.
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December 20, 2021
Insured Voided Homeowners Policy In Misrepresenting Fire Damage Losses
LITTLE ROCK, Ark. — An insured breached the terms of a homeowners insurance policy’s concealment or fraud condition when he sought benefits for the loss of furniture he alleged was destroyed in a home fire because the furniture was not in the home at the time of the fire and was not destroyed, a federal judge in Arkansas ruled Dec. 8 in granting the insurer’s motion for summary judgment.
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December 16, 2021
IFPA’s First-To-File Rule Does Not Bar Relator From Seeking All Penalties Sought
SANTA ANA, Calif. — In what it deemed an issue of first impression, a California appellate panel on Dec. 14 overturned a state trial court’s decision to sustain demurrer in a qui tam lawsuit, ruling that the Insurance Fraud Protection Act’s (IFPA) first-to-file rule does not apply to a relator insurer’s IFPA claims seeking penalties on behalf of a different pool of victims than those sought by relators in a related action against the same defendants.
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December 15, 2021
Hospice: Rule 9(b) Application In FCA Suit Not Apt To Cure Circuit Split
WASHINGTON, D.C. — U.S. Supreme Court review of an 11th Circuit U.S. Court of Appeals’ ruling affirming the dismissal of a False Claims Act (FCA) lawsuit against a hospice that allegedly paid illegal kickbacks to physicians for referrals and submitted fraudulent claims to Medicare is not warranted because although there may be a split among the federal circuit courts as to how to apply Federal Rule of Civil Procedure 9(b) in FCA cases, the instant action is a “poor vehicle to resolve them,” the hospice argues in a Dec. 13 opposition brief filed in the Supreme Court.
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December 09, 2021
Insured: Reconsideration Motion In Fire Damage Dispute Lacking In Facts
CAMDEN, N.J. — Reconsideration of a federal judge in New Jersey’s order denying an insurer’s motion for leave to file a motion for summary judgment in light of new evidence in a homeowners insurance dispute stemming from the insurer’s handling of insureds’ claim for fire losses is unnecessary because the insurer’s motion is not based on facts or sufficient allegations, an insured argues in a Dec. 8 letter brief in opposition filed in New Jersey federal court.
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December 06, 2021
Pharmacy Owner Enters Guilty Plea In Health Care Fraud Suit
BALTIMORE — A pharmacy owner who was charged with defrauding insurance companies by seeking reimbursements and payment for compounding drugs that were not ordered by a physician and were not medically necessary faces prison time and a $25,000 fine after pleading guilty on Dec. 3 in Maryland federal court to one count of payment of illegal remunerations in violation of the Anti-Kickback Statute (AKS).
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December 06, 2021
13 Defendants Plead Guilty In Multimillion-Dollar Health Care Fraud Scheme
Five more defendants in a criminal action filed by government prosecutors have pleaded guilty to charges stemming from their involvement in a multimillion scheme to defraud the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP) and TRICARE, bringing the total to 13 total defendants who have pleaded guilty in the action, according to a U.S. Department of Justice press release issued Oct. 27, as well as documents filed in Texas federal court.
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December 03, 2021
Furniture Receipt Key To Insurer’s Request For Summary Judgment Reconsideration
CAMDEN, N.J. — An insurer asked a federal judge in New Jersey on Dec. 3 to reconsider his ruling denying the insurer’s motion for leave to file a motion for summary judgment in light of new evidence in a homeowners insurance dispute stemming from the insurer’s handling of the insureds’ claim for fire losses because the insurer has provided sufficient evidence showing that the insureds “continue to engage in fraud, deception and misrepresentations.
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December 03, 2021
South Carolina Chiropractor To Pay $9M Consent Judgment For AKS Violations
GREENVILLE, S.C. — A South Carolina chiropractor will pay $9 million to settle claims in a consolidated qui tam action alleging that he and several entities he owned engaged in a scheme to violate the Anti-Kickback Statute (AKS) by submitting fraudulent bills for unnecessary medical services, according to documents filed Nov. 8 in South Carolina federal court.
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December 02, 2021
Delaware High Court Addresses Certified Questions In STOLI Death Benefits Suit
WILMINGTON, Del. — The Delaware Supreme Court on Nov. 16 applied its own precedent in considering three questions certified to it by a Delaware federal court in an estate’s lawsuit challenging whether an investor has an insurable interest under Delaware law in a stranger-owned life insurance (STOLI) policy it purchased on the secondary market, answering two of the three questions in the affirmative and one in the negative.
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December 02, 2021
Split Panel Sends Insurer’s Misrepresentations Dispute Back To Trial Court
GRAND RAPIDS, Mich. — In a 2-1 per curiam opinion, a Michigan Court of Appeals panel on Nov. 23 ruled that a trial court erred in granting summary judgment in favor of the estate of an individual in a material misrepresentations dispute because an automobile insurer failed to properly plead that its insured substantially breached the terms of the parties insurance contract when she failed to notify the insurer of changes to her household.
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December 01, 2021
Panel: No Reversible Error Committed In Dismissing Insurer’s Fraud Claims
HARRISBURG, Pa. — A Pennsylvania trial court did not err in granting summary judgment in favor of medical providers and others on claims that the defendants engaged in a fraudulent topical compound pain cream prescription and kickback scheme because insurer Liberty Mutual Group Inc. and several of its related entities and underwriters (collectively, Liberty Mutual) failed to sufficiently plead that the trial court committed any reversible errors in dismissing their fraud-based claims, a Pennsylvania Superior Court panel ruled Nov. 29 in affirming.
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November 29, 2021
4 Former Insys Execs To Pay More Than $48M In Restitution For Opioid Fraud
BOSTON — A Massachusetts federal judge on Nov. 23 ordered four convicted executives of Insys Therapeutics Inc. to pay more than $48 million in restitution for their convictions in a kickback scheme for the opioid drug Subsys, most of which will be paid to insurers defrauded in the scheme.