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Mealey's Insurance Fraud

  • January 29, 2018

    Pennsylvania Panel Finds Jury Was Properly Instructed About Prescription Rules

    PHILADELPHIA — A Pennsylvania appeals court panel on Jan. 26 affirmed a doctor’s sentence for illegally prescribing opioid medications and submitting fraudulent bills to insurance companies after finding that the jury was properly instructed about the state’s standards for properly prescribing the drugs (Commonwealth of Pennsylvania v. Lawrence P. Wean, Nos. 1165 EDA 2016, 1167 EDA 2016, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 240).

  • January 29, 2018

    2nd Circuit Orders Judge To Recalculate Loss From Insurance Fraud Scheme

    NEW YORK — A federal judge in New York was ordered by a Second Circuit U.S. Court of Appeals panel on Jan. 26 to recalculate the amount of loss an insurance company incurred as part of a fraud scheme, finding that the judge erred when including $15,228 in his calculations (United States of America v. Julian Brown, No. 16-2841-cr, 2nd Cir., 2018 U.S. App. LEXIS 1943).

  • January 29, 2018

    Judge Refuses To Dismiss Indictment Over Illegal Acquisition Of Insurance

    HARRISBURG, Pa. — A federal judge in Pennsylvania on Jan. 24 ruled that the government adequately alleges that a man should face charges of mail fraud, conspiracy to commit mail fraud and conspiracy to defraud the United States as a result of his role in a scheme to illegally obtain insurance for buses that were part of a commercial transportation company (United States of America v. Yalin Liu, No. 16cr42, M.D. Pa., 2018 U.S. Dist. LEXIS 11243).

  • January 26, 2018

    11th Circuit Upholds Couple’s Conviction For $12M Insurance Fraud Scheme

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Jan. 23 refused to vacate a couple’s convictions and sentences for a $12 million insurance fraud scheme that involved their clinics overcharging Universal Health Care Insurance Co. for treatment of patients with HIV, finding that the judge did not err when admitting evidence and calculating the amount of loss sustained by the insurer (United States of America v. Gladys Fuertes, et al., No. 15-12928, 11th Cir., 2018 U.S. App. LEXIS 1900).

  • January 25, 2018

    Judge Affirms Man’s Conviction, Sentence For Auto Accident Scheme

    DALLAS — A federal judge in Texas on Jan. 23 denied a man’s motion to vacate his conviction and sentence for conspiracy to commit health care fraud for orchestrating a scheme to submit false bills to insurers for injuries occurring from automobile accidents, finding that his right to due process was not violated (Frenchitt Su-Dell Collins v. United States of America, No. 16-cv-1472-K, N.D. Texas, 2018 U.S. Dist. LEXIS 10997).

  • January 23, 2018

    Government Cannot Introduce Evidence Of Insurance Payments During Fraud Trial

    BILLINGS, Mont. —The government cannot introduce evidence regarding the extent of damages, injuries and insurance payments that resulted from a December 2012 explosion that was caused when a trucking company was hauling natural gas condensate, a federal judge in Montana ruled Jan. 22, finding that the evidence has little probative value (United States of America v. Woody’s Trucking LLC, et al., No. CR 17-138, D. Mont., 2018 U.S. Dist. LEXIS 9749).

  • January 22, 2018

    7th Circuit Upholds Fraud Sentences For Medical Office Manager, Billing Agent

    CHICAGO — A federal judge in Illinois did not err when sentencing a home health care office manager and billing specialist following their convictions for health care fraud and conspiracy to commit health care fraud, a Seventh Circuit U.S. Court of Appeals panel ruled Jan. 19, holding that the reasoning behind the sentences was correct (United States of America v. Rick E. Brown, et al., Nos. 15-3117, 15-3261, 7th Cir., 2017 U.S. App. LEXIS 1284).

  • January 18, 2018

    Judge Refuses To Remand Fraud Suit For Improper Service To Defendant Doctor

    PHILADELPHIA — A federal judge in Pennsylvania on Jan. 12 denied a motion to remand filed by Aetna Inc. and Aetna Health Management LLC, finding that their attempt to provide service to a defendant doctor accused of conspiring to submit claims for an opioid-based pain medication for cancer patients was improper because the complaint was not sent to a location with a person who could accept service on his behalf (Aetna Inc., et al. v. Insys Therapeutics Inc., et al., No. 17-4812, E.D. Pa., 2018 U.S. Dist. LEXIS 6943).

  • January 17, 2018

    Judge Finds Indictment Sufficiently Alleges Scheme To Defraud Insurer, Government

    BILLINGS, Mont. — A federal judge in Montana on Jan. 16 denied a motion to dismiss a 14-count indictment filed by a transportation company and its owner accused of concealing from their insurer that they were transporting explosives, finding that the allegations in the indictment sufficiently support conviction (United States of America v. Woody’s Trucking LLC, et al., No. CR 17-138, D. Mont., 2018 U.S. Dist. LEXIS 6816).

  • January 16, 2018

    Judge Abstains From Workers’ Compensation Coverage Dispute

    CHARLESTON, S.C. — A federal judge in South Carolina on Jan. 11 granted a construction company’s motion to reconsider a ruling denying its motion to dismiss, finding that the South Carolina Workers’ Compensation Commission (SCWCC) should determine if an insurance policy issued to the company was in place at the time a man’s claim was filed (Owners Insurance Company v. Warren Mechanical LLC, No. 16-cv-0668-DCN, D. S.C., 2018 U.S. Dist. LEXIS 5187).

  • January 16, 2018

    Appeals Court: Perjury, Workers’ Compensation Fraud Sentences Were Authorized

    LOS ANGELES — A California appeals court panel on Jan. 11 found that a man found guilty of workers’ compensation fraud should serve three years because the sentence is allowed by the California Insurance Code and because the defendant did not object to the sentence to the trial court judge (People v. Luis Hernandez, No. B279922, Calif. App., 2nd Dist., 5th Div., 2018 Calif. App. Unpub. LEXIS 265).

  • January 11, 2018

    3rd Circuit Vacates Order Saying GEICO Need Not Pay $2.1M In Pending Claims

    PHILADELPHIA — A Third Circuit U.S. Court of Appeals panel on Jan. 10 reversed a federal judge in New Jersey’s ruling that allowed the Government Employees Insurance Co. (GEICO) to withhold payment on $2.1 million in pending personal injury protection (PIP) claims submitted by a neurology and rehabilitation facility, holding that under the New Jersey Automobile Insurance Cost Reduction Act, the dispute is subject to arbitration (Government Employees Insurance Co. v. Tri County Neurology & Rehab LLC, No. 17-2113, 3rd Cir., 2018 U.S.  App. LEXIS 617).

  • January 9, 2018

    Judge Finds Fraud Claims Against Pharmacy Owners Are Sufficiently Pleaded

    ST. LOUIS — A pharmacy benefits management company sufficiently accused two pharmacy owners of willfully submitting fraudulent bills for prescription drugs and compounds that contained ingredients not covered by insurance to obtain more than $1 million, a federal judge in Missouri ruled Dec. 29 in denying the defendants’ motion to dismiss (Express Scripts Inc., et al. v. Pharmland LLC, No. 15CV1251, E.D. Mo., 2017 U.S. Dist. LEXIS 213126).

  • January 9, 2018

    Appeals Court Finds Evidence Supported Woman’s Conviction For Insurance Fraud

    LAS VEGAS — The Nevada Court of Appeals on Dec. 29 found that evidence presented by the state during a four-day trial supported the jury’s finding that she was guilty of insurance fraud for telling an insurance company that her car was stolen and set on fire (Candace Alderman v. State of Nevada, No. 71702, Nev. App., 2017 Nev. App. Unpub. LEXIS 963).

  • January 8, 2018

    Woman Sentenced To 51 Months For $2M Kickback, Referral Scheme

    NEW ORLEANS — A federal judge in Louisiana on Jan. 4 sentenced a woman to 51 months in prison and ordered her to pay $1.9 million in restitution after she was found guilty for her role in a $2 million Medicare scheme that involved paying and receiving kickbacks for home health care referrals (United States of America v. Milton Diaz, et al., No. 15-cr-232, E.D. La.).

  • January 5, 2018

    Magistrate Judge Denies Gynecologist’s Request For Grand Jury Instructions

    BOSTON — A gynecologist accused of wrongfully providing a pharmaceutical drug sales representative access to patients’ confidential health information cannot have access to instructions provided to two grand juries, a federal magistrate judge in Massachusetts ruled Jan. 3, holding that the information could not support her claim for vindictive prosecution (United States of America v. Rita Luthra, No. 15-cr-30032, D. Mass., 2018 U.S. Dist. LEXIS 604).

  • January 3, 2018

    Majority: Material Misrepresentation On Insurance Application Warrants Rescission

    PASADENA, Calif. — A majority of the Ninth Circuit U.S. Court of Appeals on Jan. 2 affirmed a lower federal court’s finding that an insured’s material misrepresentation on an application for directors and officers liability insurance warranted rescission of the policy (Western World Insurance Company v. Professional Collection Consultants, No. 16-55470 and 15-2342, 9th Cir., 2018 U.S. App. LEXIS 73).

  • December 28, 2017

    Judge Denies New Trial For Man Convicted Of Illegally Obtaining Benefits

    HARRISBURG, Pa. — A federal judge in Pennsylvania on Dec. 21 denied a motion for a new trial filed by a man convicted of illegally obtaining Social Security and life insurance benefits that were intended for his daughters, holding that the exclusion of a county court order did not have a substantial influence on the jury’s decision (United States of America v. Mohammed Rizk, No. 16-cr-214, M.D. Pa., 2017 U.S. Dist. LEXIS 209651).

  • December 22, 2017

    Judge: Insurers Have No Statutory Duty To Pay No-Fault Benefits Claims

    DETROIT — A federal judge in Michigan on Dec. 21 granted State Farm Mutual Automobile Insurance Co.’s motion to reconsider and dismissed a health medical practices counterclaims for fraud, civil conspiracy and declaratory relief, finding that pursuant to the Michigan Supreme Court’s ruling in Covenant Med. Ctr., Inc. v. State Farm Mut. Auto. Ins. Co., 500 Mich. 191, 895 N.W.2d 490, 505 (2017), State Farm is not required to pay claims for no-fault benefits submitted by health care providers (State Farm Mutual Automobile Insurance Company v. Universal Rehab Services Inc., et al., No. 15-10993, E.D. Mich., 2017 U.S. Dist. LEXIS 210318).

  • December 22, 2017

    Father, Son Sentenced For Conspiracy To Commit Health Care Fraud

    CAMDEN, N.J. — A father and son were sentenced by a federal judge in New Jersey on Dec. 13 for conspiring to defraud Medicare by allowing unqualified individuals to provide physical therapy to patients, but billing the insurer as if they were there (United States of America v. Robert Claude McGrath, et al., No. 17cr215, D. N.J.).