Mealey's Insurance Fraud

  • 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.

  • 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.

  • November 24, 2021

    False Claims Act Claims In Qui Tam Suit Pass Muster; Conspiracy Claims Do Not

    TRENTON, N.J. — A relator in a qui tam action against a health care organization, its president and two of its employees and others has sufficiently pleaded factual allegations in support of her claims that the defendants violated state and federal false claims statutes by engaging in a scheme to defraud federal health insurance providers for products the defendants sold to patients by submitting fraudulent claims for reimbursement, a federal judge in New Jersey ruled Nov. 22 in granting in part the defendants’ motion to dismiss and denying it in part.

  • November 24, 2021

    11th Circuit Panel Upholds Convictions In Pharmacy’s Health Care Fraud Scheme

    ATLANTA — In a per curiam opinion, an 11th Circuit U.S. Court of Appeals panel on Nov. 22 upheld the convictions of two men charged with orchestrating a multimillion dollar health care fraud scheme, ruling, inter alia, that a federal district court properly determined that the fourth superseding indictment against the men was sufficient, allowing certain evidence to be entered into the record and determining that federal prosecutors did not engage in any misconduct during trial.

  • November 22, 2021

    Allstate:  Funding Company’s Counterclaims Fall Short Of Pleading Standard

    DETROIT — Dismissal of a medical funding company’s claims in a countercomplaint is necessary because the defendant has failed to identify any actual harm it suffered as a result of an insurer’s denial of payment of no-fault insurance benefits and, therefore, has failed to sufficiently state a claim for relief, insurers argue in a Nov. 18 motion to dismiss filed in Michigan federal court.

  • November 18, 2021

    Man Ordered To Serve 3 Years In Prison In Crop Insurance Fraud Scheme

    LEXINGTON, Ky. — A federal judge in Kentucky on Nov. 17 issued an amended judgment in a criminal action ordering an insured to serve 36 months in prison and pay nearly $3 million in criminal penalties stemming from his role in an alleged crop insurance scheme in which he and others defrauded federal crop insurers by making material misrepresentations in policy applications.

  • November 17, 2021

    Panel Affirms Summary Judgment In Favor Of Insurers In Fraudulent Billing Suit

    ATLANTA — A federal district court committed no reversible error when it granted an insurer’s motion for summary judgment against a health care clinic and several of its employees stemming from their alleged involvement in a fraudulent billing scheme because none of the reimbursements the clinic sought was reimbursable under Florida’s no-fault law, an 11th Circuit U.S. Court of Appeals panel ruled Nov. 5 in affirming.

  • November 16, 2021

    Jury Verdict In Hotelier’s Fraudulent Insurance Claim Lawsuit Allowed To Stand

    ORLANDO, Fla. — In a Nov. 5 opinion, a federal judge in Florida denied an insured hotel operator’s motions during trial for a mistrial, sanctions, a new trial and judgment as a matter of law in an insurance dispute stemming from the insured’s alleged filing of a fraudulent commercial property insurance claim for a hotel allegedly damaged by Hurricane Irma, ruling that the insured failed to sufficiently show that it was entitled to any of the relief it sought.

  • November 12, 2021

    Relator Appeals Dismissal Of False Claims Statute Violations To 9th Circuit

    LOS ANGELES — A relator in a qui tam lawsuit against pharmacies alleged to have engaged in a fraudulent scheme to induce public and private insurers to grant prior authorizations for prescriptions will appeal a federal judge’s dismissal with prejudice of his state and federal false claims act claims, according to a notice of appeal the relator filed Nov. 10 in California federal court.

  • November 09, 2021

    Orthopedic Device Maker Arthrex To Pay $16M For ‘Royalty’ Kickbacks

    BOSTON — The United States on Nov. 8 signed a settlement under which orthopedic device maker Arthrex Inc. will pay $16 million for causing false claims to be filed through a royalty agreement with an orthopedic surgeon.

  • November 05, 2021

    Relator’s State, Federal False Claims Law Allegations Deemed Insufficient

    LOS ANGELES — A federal judge in California on Oct. 12 dismissed with prejudice a relator’s state and federal claims act claims against pharmacies who are alleged to have engaged in a fraudulent scheme to induce public and private insurers to grant prior authorizations for prescriptions, ruling that the relator failed to cure any of the pleading deficiencies that led to a prior dismissal of his claims.

  • November 05, 2021

    Magistrate Judge Strikes Insurer’s Fraud Defense In Bad Faith Lawsuit

    GREENVILLE, Miss. — A federal magistrate judge in Mississippi on Nov. 2 denied an automobile insurer’s motion to amend its answer to state an affirmative defense for fraud in an insurance breach of contract and bad faith lawsuit stemming from an alleged hit-and-run accident, ruling that the insurer has failed to sufficiently plead any facts supporting its allegation that the insured acted fraudulently in filing his claim.

  • November 05, 2021

    Aetna’s Improperly Dismissed Insurance Fraud Suit Headed Back To Trial Court

    CAMDEN, N.J. — A New Jersey trial court erred in dismissing state insurance fraud claims brought by Aetna Health Inc. and Aetna Life Insurance Co. (collectively, Aetna) against the alleged operators of a fraudulent billing scheme and others because the insurer sufficiently pleaded that two of the scheme’s operators not only concealed their actions but also knowingly benefited from it, a New Jersey Superior Court Appellate Division panel ruled Oct. 7 in reversing and remanding.

  • November 05, 2021

    Law Firm Appeals FCA First-To-File Bar Holding To U.S. Supreme Court

    WASHINGTON, D.C. — The U.S. Supreme Court should grant review of a Fifth Circuit U.S. Court of Appeals’ ruling affirming a federal district court’s dismissal of relator claims and its denial of attorney fees and costs for the relators’ counsel as barred by the False Claims Act’s (FCA) first-to-file bar because the claims made in the underlying action were not based on the same set of facts forming the basis of a related qui tam action filed against the defendants, an attorney and his law firm argue in an Oct. 16 petition for a writ of certiorari.

  • November 04, 2021

    Panel: Weight Of Evidence Supports Man’s Workers’ Compensation Fraud Conviction

    COLUMBUS, Ohio — An Ohio appellate panel on Oct. 14 upheld a man’s conviction on charges of workers’ compensation fraud and grand theft, ruling that the manifest weight of the evidence supported a jury’s finding that the man intended to defraud the Ohio Bureau of Workers’ Compensation (BWC) by engaging in gainful employment while receiving temporary total disability (TTD) benefits.

  • November 02, 2021

    Claim For Reverse False Claims In Qui Tam Suit Permitted To Proceed

    DALLAS — A federal judge in Texas on Oct. 20 ruled that government prosecutors in a qui tam lawsuit stemming from an alleged insurance billing fraud scheme have sufficiently alleged their claim for reverse false claims under the False Claims Act (FCA) because the government properly pleaded that the defendants had an obligation to pay the government and because the government’s claim is not redundant of other claims brought against the defendants.

  • November 01, 2021

    Insured Appeals Summary Judgment Ruling In Insurance Fraud Suit To 2nd Circuit

    NEW YORK — An insured sued by his disability income insurer in an insurance fraud dispute filed a notice of appeal in New York federal court on Oct. 27, indicating that he is appealing to the Second Circuit U.S. Court of Appeals the lower court’s grant of summary judgment in which the judge ruled that the insured lacked a coverable disability warranting coverage.

  • November 01, 2021

    Relator, States’ Claims In FCA Kickback Qui Tam Suit Survive Dismissal Bid

    NASHVILLE, Tenn. — A federal judge in Tennessee on Oct. 27 declined to dismiss state and federal false claims act claims in a qui tam lawsuit brought by a relator and the states of Tennessee and Louisiana against a provider of mobile dental care services for long-term care (LTC) facilities and several of its affiliates stemming from an alleged Medicaid kickback scheme because the plaintiffs have sufficiently shown that the defendants’ business model violated the federal Anti-Kickback Statute (AKS).

  • November 01, 2021

    Insurance Fraud Defendants Waived Privilege, Must Submit Attorney Communications

    GREENVILLE, Tenn. — The Tennessee federal judge overseeing a three-year-old insurance fraud case on Oct. 26 issued an order clarifying that the defendants had waived any attorney-client privilege in attorney communications that relate to one defendant’s advice-of-counsel defense, ordering that all such documents be immediately submitted to the government in response to its motion to compel.

  • October 28, 2021

    Washington High Court Input On Validity Of Life Insurance Policy Clause Sought

    SEATTLE — A federal judge in Washington on Oct. 20 certified a question to the Washington Supreme Court in a life insurance dispute over an insurer’s denial of benefits to a beneficiary, seeking the state high court’s determination whether life insurers may deny coverage based on alleged fraud even though policies contain incontestability clauses and state law states that such action by insurers may not occur.

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