GRAND RAPIDS, Mich. — A Michigan appeals panel on May 7 overturned a trial court judge’s denial of an insurance company’s motion for summary judgment, finding that the insurer is not required to pay personal injury protection (PIP) benefits on a woman’s claim because she made fraudulent statements about working at the International House of Pancakes (IHOP) at the time of the accident, about the amount she was paid and about how long her shifts were (Daisian Wright v. Farm Bureau General Insurance Co. of Michigan, No. 347112, Mich. App., 2020 Mich. App. LEXIS 3250).
DETROIT — A doctor was charged with counts of health care fraud and conspiracy to commit health care fraud in a criminal complaint filed in federal court in Michigan on April 24 for fraudulently billing Medicare and private insurers for treating patients with high-dose vitamin C injections to treat and prevent the contraction of COVID-19 (United States v. Charles Mok, No. 20cr, E.D. Mich.).
TAMPA, Fla. — A federal magistrate judge in Florida on May 5 granted in part an insurer’s motion to compel seeking financial records, tax returns and the general ledger of a windshield company accused of submitting false claims for replacement, holding that while the insurance company can have access to the ledger, more discovery is needed to determine if it should be allowed to have copies of the tax returns and other financial information (Government Employees Insurance Co., et al. v. Sean Martineau, et al., No. 19-cv-1382-T-35SPF, M.D. Fla., 2020 U.S. Dist. LEXIS 78816).
BATON ROUGE, La. — An insolvent insurer’s directors and officers filed motions on April 30 asking a Louisiana federal court to dismiss a rehabilitator’s breach of fiduciary duty lawsuit alleging that they intentionally misled state insurance regulators on the insurer’s true financial condition (James J. Donelon v. Jeffrey C. Pollick, et al., No. 20-177, M.D. La.).
AIKEN, S.C. — An attorney for a man who pleaded guilty to participating in a scheme to submit applications for life insurance policies that included false information about the individual’s income, health and mortgage information acted effectively when representing him because the attorney was not required to cite cases from beyond the Fourth Circuit U.S. Court of Appeals, a federal judge in South Carolina ruled May 1 in denying the defendant’s motion to vacate his five-year prison sentence (United States v. Douglas Wade Williamson, No. 17-cr-987-JMC-11, D. S.C., 2020 U.S. Dist. LEXIS 77627).
AUSTIN, Texas — The Texas Supreme Court on May 1 reversed an appeals court’s ruling and reinstated a trial court’s ruling in favor of an insurer after determining that the trial court correctly considered extrinsic evidence when it concluded that an insured and a third party suing the insured colluded to make false representations in an underlying suit arising out of an auto accident (Loya Insurance Co. v. Osbalto Hurtado Avalos, et al., No. 18-0837, Texas Sup., 2020 Tex. LEXIS 373).
ASHEVILLE, N.C. — A clinical laboratory services company entered into an agreement in federal court in North Carolina to pay up to $43 million to resolve claims brought by a whistleblower doctor, the federal government and the state in a False Claims Act (FCA) suit alleging that it submitted fraudulent bills for tests that were not medically necessary, according to April 27 court filings (United States, ex rel. Daryl Landis v. Genova Diagnostics Inc., No. 17-341, W.D. N.C.).
CHICAGO — A federal judge in Illinois on April 28 denied a doctor’s motion for acquittal and/or new trial, holding that the evidence presented by the government sufficiently supported his convictions for a fraudulent billing scheme involving manipulations under anesthesia (MUA) (United States v. Paul Madison, No. 12-cr-1004-1, N.D. Ill., 2020 U.S. Dist. LEXIS 74230).
PHILADELPHIA — A federal judge in Pennsylvania on April 24 sentenced a Florida man to 15 months plus one day in prison and ordered him to pay $3.4 million in restitution after he pleaded guilty to participating in a scheme involving the payment of kickbacks for medically unnecessary urine tests for patients receiving treatment at a drug and alcohol rehabilitation facility, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced (United States v. Jesse Peters, No. 19cr174, E.D. Pa.).
BATON ROUGE, La. — An insolvent insurer’s rehabilitator in an April 23 memorandum asks a Louisiana federal court to remand a suit against the insurer’s various directors and officers, banks and a loan officer over allegations that they intentionally misled state insurance regulators on the insurer’s true financial condition (James J. Donelon v. Jeffrey C. Pollick, et al., No. 20-177, M.D. La.).
PHILADELPHIA — A Third Circuit U.S. Court of Appeals panel on April 22 affirmed a man’s 50-month sentence for conspiracy to commit health care fraud, finding that a federal judge in New Jersey did not err when enhancing the defendant’s sentence because the scheme targeted elderly patients and used a charitable organization as a pretense and because he was a leader of the plan (United States v. Seth Rehfuss, No. 19-2166, 3rd Cir., 2020 U.S. App. LEXIS 12915).
DETROIT — Medical providers cannot pursue a counterclaim for fraudulent misrepresentation against two insurers, a federal judge in Michigan ruled April 21, holding that the assignments of claims signed by insureds did not give the providers the right to assert tort claims against the companies (Liberty Mutual Fire Insurance Co., et al. v. Michael Angelo, et al., No. 19-12051, E.D. Mich., 2020 U.S. Dist. LEXIS 70075).
SYRACUSE, N.Y. — A medical transportation driver was sentenced to 18 months in federal prison and ordered to pay $50,000 in restitution by a federal judge in New York on April 21 after the defendant pleaded guilty in July 2018 to charges of conspiracy to defraud the United States and health care fraud (United States v. Anthony A. Armstrong, No. 18cr190, N.D. N.Y.).
HATTIESBURG, Miss. — A federal judge in Mississippi on April 15 granted in part an insurance fraud defendant’s motion for multidivision jury venire, finding that while an upcoming trial can be held in the same division, measures should be taken to expand the pool of potential jurors (United States v. Wade Ashley Walters, No. 19-cr-51-KS-MTP, S.D. Miss., 2020 U.S. Dist. LEXIS 66400).
NORFOLK, Va. — Saber Healthcare Group LLC and related entities have agreed to pay $10 million to resolve claims that they violated the False Claims Act (FCA) by causing some of its nursing home facilities to submit claims to Medicare for rehabilitation services that were not reasonable, necessary or skilled, the U.S. Department of Justice (DOJ) announced in an April 14 press release (United States ex rel. Hope Wright, et al. v. Saber Healthcare Holdings, LLC., et al., No. 16-cv-640, E.D. Va.).
CHICAGO — A federal judge in Illinois on March 26 found that a former chief medical officer of a third-party company hired by insurers participating in Medicare Advantage (MA) plans to conduct preauthorization screenings sufficiently stated a claim against the company under the False Claims Act regarding its screening protocol, but dismissed her cause of action against the parent company (United States, ex rel. Susan Nedza v. American Imaging Management Inc., et al., No. 15 C 6937, N.D. Ill., 2020 U.S. Dist. LEXIS 52415).
DETROIT — A company that provides rehabilitation services to more than 600 health care facilities in more than 30 states on March 31 entered into agreements in federal court in Michigan that require it to pay a total of $4 million to resolve allegations in three whistleblower suits brought under the False Claims Act (FCA) that accuse it of engaging in conduct that resulted in the submission of fraudulent bills submitted to Medicare by three skilled nursing facilities in Michigan (United States ex rel. Linda Anderson v. Encore Rehabilitation Services LLC, No. 14-cv-13759, E.D. Mich.,United States ex rel. Reza Saffarian, et al. v. Encore Rehabilitation Services LLC, et al., No. 16-cv-605, W.D. Mich., United States, et al., ex rel. Adam LaFerriere v. Encore Rehabilitation Services LLC, et al., No. 17-cv-95, W.D. Mich.).
PHILADELPHIA — A federal judge in Pennsylvania on March 31 denied an insurance company’s motion for summary judgment in a lawsuit seeking to void a professional liability policy issued to a woman’s health care practice, finding that there is insufficient evidence to create a genuine dispute as to whether the insureds could have anticipated the filing of two medical malpractice lawsuits when completing the policy application (MDAdvantage Insurance Company of New Jersey v. Aaron S. Hasiuk M.D., et al., No. 16-969, E.D. Pa., 2020 U.S. Dist. LEXIS 55614).
NASHVILLE, Tenn. — A regional hospital agreed to pay $1.7 million to resolve allegations that it violated the False Claims Act (FCA) when submitting unsubstantiated claims to Medicare for treatments from April 2013 through March 31, 2019, the U.S. Attorney’s Office for the Middle District of Tennessee announced April 13.
FRANKFORT, Ky. — A Kentucky appeals panel on April 10 affirmed two rulings in favor of Allstate Insurance Co., finding that a couple should undergo an examination under oath (EUO) to determine if injuries they sought personal injury protection (PIP) coverage for resulted from an automobile accident and that the lack of an EUO supported a ruling awarding summary judgment to the insurer in a separate action brought by the insureds demanding payment on the claim (Kelvin Thomas, et al. v. Allstate Insurance Co., Nos. 2016-CA-000939, 2017-CA-001019-MR, Ky. App., 2020 Ky. App. Unpub. LEXIS 253).