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Mealey's Insurance Fraud

  • April 11, 2018

    Appeals Court Affirms Psychologist’s Sentence For Fraud, Indecent Assault

    HARRISBURG, Pa. — A Pennsylvania appeals panel on April 6 affirmed a trial court judge’s ruling sentencing a former psychologist to three to six years in prison for sexually assaulting two of his patients and submitting bills to their insurance companies for the treatments, finding that the judge properly relied on a presentence investigation (PSI) report when rendering his decision (Commonwealth of Pennsylvania v. Richard Scott Lenhart, No. 1070 MDA 2017, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 1099).

  • April 9, 2018

    Judge Affirms Chiropractor’s, Runners’ Convictions For Roles In Fraud Scheme

    MINNEAPOLIS — The government presented sufficient evidence to prove that three individuals conspired to illegally refer automobile accident victims to a chiropractic clinic that submitted bills to insurance companies for medically unnecessary treatments because misrepresentations they made to the companies were material and intended to defraud them, a federal judge in Minnesota ruled April 5 in denying their motions for acquittal (United States of America v. Preston Ellard Forthun, et al., No. 16-339, D. Minn., 2018 U.S. Dist. LEXIS 58214).

  • April 8, 2018

    Judge Enters Default Judgment Against Doctor Accused Of Fraudulent Billing Scheme

    NEWARK, N.J. — A federal judge in New Jersey on April 5 entered default judgment against a doctor accused of participating in a scheme to submit fraudulent bills to Government Employees Insurance Co. (GEICO) for treating patients allegedly injured in automobile accidents and ordered him to pay $7.3 million, finding that the insurer sufficiently stated claims against the physician for fraud, unjust enrichment and violation of the New Jersey Insurance Fraud Prevention Act (IFPA) (Government Employee Insurance Co. v. Lyudmila Poretskaya, M.D., et al., No. 16-08448, D. N.J., 2018 U.S. Dist. LEXIS 58102).

  • March 30, 2018

    7th Circuit: Judge Erred When Making Property Interest Ruling In Fraud Case

    CHICAGO — A federal judge in Wisconsin erred when finding how much of a couple’s property the government could seek in restitution after the husband was sentenced for committing insurance fraud, a Seventh Circuit U.S. Court of Appeals panel ruled March 28, finding that the judge should have considered only the couple’s financial situation at the time the restitution judgment was entered rather than when the defendant was resentenced in April 2015 (United States of America v. John E. Henricks III, No. 17-2383, 7th Cir., 2018 U.S. App. LEXIS 7596).

  • March 26, 2018

    Judge Rules Expert Cannot Testify For Doctor Accused Of Health Care Fraud

    LONDON, Ky. — A federal judge in Kentucky on March 25 barred an expert from testifying about the national average of pacemakers that were implanted in patients from 2012 to 2014 on behalf of a doctor accused of defrauding Medicare by implanting pacemakers in patients who did not need them, finding that the expert’s disclosure was untimely (United States of America v. Anis Chalhoub M.D., No. 16-cr-00023-GFHT-HAI, E.D. Ky.,2018 U.S. Dist. LEXIS 49775).

  • March 26, 2018

    9th Circuit Upholds Amount Of Loss Medicare Sustained From Fraud Scheme

    PASADENA, Calif. — A federal judge in California did not err when ordering a woman who pleaded guilty to health care fraud to pay $4 million in restitution, a Ninth Circuit U.S. Court of Appeals panel ruled March 23, finding that the judge did not err when calculating the amount of loss (United States of America v. L’Tanya Denise Smith, No. 16-50322, 9th Cir., 2018 U.S. App. LEXIS 7411).

  • March 21, 2018

    Substantial Evidence Supports Summary Judgment In Bad Faith Suit, Judge Rules

    SAN FRANCISCO — An insurer did not act in bad faith in its handling of an automobile insurance claim because “substantial evidence” uncovered in the insurer’s claim investigation outweighed an insured’s assertions regarding the alleged theft of her vehicle, a federal judge in California ruled March 16 in granting the insurer’s summary judgment motion (Kevineshia Island v. State Farm Fire and Casualty Co., et al., No. 16-5449, N.D. Calif., 2018 U.S. Dist. LEXIS 44737).

  • March 15, 2018

    Judge Finds Superseding Indictment Sufficiently Alleges Fraudulent Scheme

    MINNEAPOLIS — A federal judge in Minnesota on March 12 denied a man’s motion to dismiss a superseding indictment charging him with conspiracy to commit health care fraud, finding that the allegations in the indictment adequately alleged that he was a runner who recruited patients to go to a chiropractic clinic that submitted fraudulent claims to insurance companies (United States v. Angela April Schulz, et al., No. 16-341, D. Minn., 2018 U.S. Dist. LEXIS 41145).

  • March 12, 2018

    Judge Enters Default Judgment Against Clinic Owners, Orders Them To Pay $2.3M

    TRENTON, N.J. — A federal judge in New Jersey on March 9 entered default judgment against a radiology clinic and four of its owners who are accused of submitting fraudulent bills to the Government Employees Insurance Co. (GEICO) for reimbursement under patients’ no-fault personal injury protection (PIP) and ordered them to pay $2.3 million, finding that the defendants failed to raise at litigable defense (Government Employees Insurance Co., et al. v. Hamilton Health Care Center PC., et al., No. 17-0674, D. N.J., 2018 U.S. Dist. LEXIS 38902).

  • March 12, 2018

    Dermatologist Agrees To Pay $2.5M To Resolve False Claims Act Allegations

    FORT PIERCE, Fla.— A federal judge in Florida on March 7 dismissed a lawsuit accusing a dermatologist of violating the False Claims Act when billing Medicare and TRICARE, which provides health benefits for U.S. Armed Forces personnel, for muscle flap procedures that were not performed after the doctor agreed to pay $2.5 million to resolve the allegations (United States, ex rel. Patricia Cleary v. Tim Ioannides, M.D., et al., No. 15-14306, S.D. Fla.).

  • March 8, 2018

    Woman Lacks Standing To Attempt To Vacate Insurance Fraud Sentence, Judge Finds

    NEW YORK— A federal judge in New York on March 6 denied a woman’s motion to vacate her sentence for conspiracy to commit insurance fraud, finding that she lacked standing because she was not “in custody” at the time she filed her motion (Seritta Klass v. United States of America, No. 11 cr 893, S.D. N.Y., 2018 U.S. Dist. LEXIS 36511).

  • March 7, 2018

    Judge Finds Fraudulent Billing Scheme Resulted In $73.4M Of Intended Losses

    WEST PALM BEACH, Fla. — A federal judge in Florida on Feb. 21 found that a doctor’s fraudulent billing scheme resulted in Medicare losing more than $73.4 million, warranting an enhancement of his sentence (United States of America v. Salomon E. Melgen, No. 15-80049-CR-MARRA, S.D. Fla., 2018 U.S. Dist. LEXIS 31012).

  • March 7, 2018

    Judge: Man Must Pay Restitution To Insurer As Part Of Plea

    GEORGETOWN, Del. — A man who pleaded guilty to submitting a fraudulent insurance claim must pay $225,639.70 in restitution to the insurance company, a Delaware judge ruled Feb. 21, finding that a payment plan can be implemented to accommodate his alleged inability to pay (Delaware v. Robert S. Bangs, No. 1702000830, Del. Super., Sussex Co., 2018 Del. 88).

  • March 6, 2018

    6th Circuit Orders Trial On Nursing Director’s Claim That Fraud Forced Her To Quit

    CINCINNATI — A home health care provider’s former director of nursing may proceed with her claims that she was forced to resign due to her employer’s decision to seek and receive fraudulent reimbursements from the federal government as a jury may determine that the employer’s alleged fraud “plus the employee’s moral conscience and reasonable fear of being accused of participating in the employer’s fraud is enough to justify quitting,” a Sixth Circuit U.S. Court of Appeals panel ruled March 2 (Sue Smith v. LHC Group, Inc., et al., No. 17-5850, 6th Cir., 2018 U.S. App. LEXIS 5345).

  • March 6, 2018

    Appeals Court Upholds Man’s Conviction For Arson, Insurance Fraud

    PHILADELPHIA — A Pennsylvania appeals court on Feb. 27 affirmed a man’s conviction for arson and insurance fraud, finding that the trial court judge did not err in admitting evidence from two fires that occurred in March 2011, as well as testimony from the fire chief in which he concluded that the cause of the fire was an incendiary device (Pennsylvania v. John Edward Chairmonte, No. 2815 EDA 2015, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 590).

  • March 6, 2018

    Magistrate Judge Orders Medical Providers To Turn Over Documents From Database

    LOS ANGELES — Medical service providers accused by UnitedHealth Group Inc. of submitting fraudulent bills were ordered by a federal magistrate judge in California on March 2 to provide responsive documents that are contained in a database, finding that the company that has the software license for the database is an alter ego of the providers (Almont Ambulatory Surgery Center LLC, et al. v. UnitedHealth Group Inc., et al., No. CV 14-03053-MWF, C.D. Calif., 2018 U.S. Dist. LEXIS 35616).

  • March 2, 2018

    Insurer Provided Sufficient Evidence Of Chiropractor’s Billing Scheme, Judge Says

    SEATTLE — State Farm Mutual Automobile Insurance Co. and State Farm Fire and Casualty Co. presented sufficient evidence showing that a chiropractor routinely submitted bills for reimbursement under patients’ personal injury protection (PIP) for treatment that was not medically necessary, a federal judge in Washington ruled Feb. 27 in denying the chiropractor’s motion for summary judgment (State Farm Mutual Automobile Insurance Co., et al. v. Peter J. Hanson, et al., No. C16-1085RSL, W.D. Wash., 2018 U.S. Dist. LEXIS 31799).

  • March 2, 2018

    Judge: Claims Question Appropriateness Of Chiropractor’s Professional Services

    SEATTLE — A Washington federal judge on Feb. 27 denied a professional liability insurer’s motion for summary judgment in its lawsuit disputing coverage for underlying claims that a chiropractor insured submitted misleading, false and/or fraudulent bills to obtain personal injury protection (PIP) payments from his patients’ auto insurer (PACO Assurance Company, Inc. v. Peter J. Hanson, No. 17-0649, W.D. Wash., 2018 U.S. Dist. LEXIS 31832).

  • March 2, 2018

    6th Circuit Panel Denies Health Care Defendants’ Motion For Release Pending Appeal

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Feb. 28 denied motions filed by five defendants seeking to be released on bail pending the appeals of their convictions for health care fraud, holding that they did not satisfy their burden of showing that their appeals raise a substantial question of law or fact as to warrant relief under the Bail Reform Act (United States of America v. Robert L. Bertram Jr., et al., Nos. 17-6527, 17-6528, 18-5001, 18-5002, 6th Cir., 2018 U.S. App. LEXIS 5104).

  • February 28, 2018

    State Farm Can Amend Suit Over Fraud Scheme, Judge Rules

    MIAMI — State Farm Mutual Automobile Insurance Co. can amend a second amended complaint to remedy deficiencies in allegations that a clinic is subject to the requirements of the Health Care Clinic Act (HCCA) for allegedly receiving payments from third parties for inflated bills it prepared for patients involved in motor vehicle accidents, a federal judge in Florida ruled Feb. 16, finding that an amendment would not be futile (State Farm Mutual Automobile Insurance Company v. Performance Orthopaedics & Neurosurgery LLC, et al., No. 17-CV-20028-KMM, S.D. Fla., 2018 U.S. Dist. LEXIS 26841).