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Mealey's Insurance Fraud

  • February 25, 2021

    Magistrate: Rehab Clinic Co-Owner’s 10-Year Prison Sentence Should Not Be Vacated

    MIAMI — A federal magistrate judge in Florida on Feb. 23 recommended denying a motion to vacate filed by a man who was sentenced to 10 years in prison after pleading guilty to conspiracy to commit health care fraud, finding that his counsel was effective during sentencing and the appellate process.

  • February 24, 2021

    Judge Trims False Claims Act Allegations Against Nursing Home Owners

    PHILADELPHIA — A federal judge in Pennsylvania on Feb. 5 granted in part a motion to dismiss filed by Kindred Healthcare Inc. and a number of its subsidiaries, finding that a relator in a False Claims Act (FCA) lawsuit failed to sufficiently allege that they misrepresented their compliance with staffing requirements to receive larger reimbursements from Medicare and Medicaid and that they inappropriately used government funding received from the insurers.

  • February 23, 2021

    Potential Coverage Exists For Challenge To McDonald’s Steps To Contain COVID-19

    CHICAGO — A federal judge in Illinois on Feb. 22 denied a commercial general liability insurer’s motion to dismiss a breach of contract and declaratory relief lawsuit brought by McDonald’s Corp. and former and current franchise owners seeking coverage for an underlying class action injunction alleging that they are taking inadequate steps to contain COVID-19 in the workplace.

  • February 23, 2021

    Couple’s Request For New Trial Over Insurance Fraud Denied By Judge

    LOS ANGELES — A federal judge in California on Feb. 17 denied requests for a new trial and a reduction of punitive damages filed by a couple who were found liable by a jury for submitting false claims for benefits under long-term care policies they had from Lincoln Life Benefit Co., finding that the jury’s decision did not go against the weight of the evidence on the issue of the statute of limitations and that the couple’s conduct warranted the $300,000 punitive damages award.

  • February 22, 2021

    Michigan Appeals Court: Insurer’s Fraud Defense Barred By Res Judicata

    GRAND RAPIDS, Mich. — A Michigan appeals court on Feb. 18 vacated a ruling awarding summary judgment to an insurer in a suit brought by a medical practice seeking payment for services rendered to a woman injured in an automobile accident, finding that the insurer’s argument that it is not required to pay for the services based on the fraudulent activity of the policyholder was barred by the doctrine of res judicata.

  • February 18, 2021

    Magistrate Judge Dismisses False Claims Act Suit Against Opioid Maker

    OAKLAND, Calif. — A federal magistrate judge in California on Feb. 16 dismissed with prejudice a False Claims Act (FCA) lawsuit brought by two former McKesson Corp. employees, finding that the allegations in their second amended complaint (SAC) did not sufficiently allege that the opioid maker submitted false claims for payment to the federal government pursuant to the U.S. Supreme Court’s 2016 ruling in Universal Health Servs. Inc. v. United States, ex rel. Escobar.

  • February 17, 2021

    Judge Finds No Compelling Reason For Convicted Fraud Defendant’s Early Release

    DETROIT — A federal judge in Michigan on Feb. 12 rejected a motion for compassionate release filed by a man who was sentenced to more than 100 years in prison for engaging in a scheme to intentionally set fire to buildings for the purpose of submitting insurance claims, overruling his arguments that he should be released immediately due to the COVID-19 pandemic and because he misses his family.

  • February 17, 2021

    9th Circuit Vacates Woman’s 14-Month Sentence For Filing False Insurance Claim

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Feb. 12 vacated a woman’s 14-month prison sentence, ruling that while a federal judge in California did not err when making four evidentiary rulings on testimony admitted during the trial, the judge did not provide any factual findings to support the sentence.

  • February 16, 2021

    Judge Denies Dismissal Of Suit Over Scheme Between Pharmacy, Nursing Homes

    ATLANTA— A federal judge in Georgia on Feb. 10 denied dismissal of a False Claims Act (FCA) lawsuit filed by a former account manager against a local pharmacy services supplier over an alleged kickback scheme between the company and nursing homes, finding that the relator’s amended complaint sufficiently alleged that the provider offered remuneration to assisted living communities (ALCs) that made the defendant company a preferred pharmacy and that the relationship between the parties resulted in the submission of fraudulent claims to insurers.

  • February 16, 2021

    Judge:  Insurer Fails To State Claims Against Billing Company Over Alleged Scheme

    DALLAS — A federal judge in Texas on Feb. 11 granted a billing company’s motion to dismiss an insurance company’s lawsuit for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6), finding that the insurer’s negligent misrepresentation claim is time-barred and that its allegations of fraud are not pleaded with the required level of specificity.

  • February 16, 2021

    Government’s $8.4M Forfeiture Order Against Fraud Defendant Approved By Judge

    WASHINGTON, D.C. — A federal judge in the District of Columbia on Jan. 28 granted the government’s request for an order requiring a convicted former insurance broker to forfeit $8.4 million, finding that the amount represented the gross proceeds of a scheme that involved him keeping inflated premiums he charged to clients for health care insurance policies.

  • February 12, 2021

    Bad Faith Claim In Fire Damage Coverage Suit Must Be Dismissed

    SOUTH BEND, Ind. — An Indiana federal judge on Feb. 11 granted a homeowners insurer’s motion for summary judgment on a claim for bad faith after determining that no reasonable juror could find that that insurer acted in bad faith in handling the insureds’ fire damage claim.

  • February 10, 2021

    Woman’s Conviction For Insurance Fraud Overturned Due To Prejudicial Testimony

    ALBANY, N.Y.  — A New York appeals court on Feb. 5 reversed a woman’s convictions for insurance fraud and submitting false business records after finding that the trial court judge should not have allowed an investigator to testify that he believed that the fire was intentionally set because the prejudice of the opinion outweighed its probative value.

  • February 09, 2021

    Government Ordered To Detail Compounding Pharmacy Owner’s Alleged Kickback Scheme

    BALTIMORE — A federal judge in Maryland on Feb. 5 ordered the federal government to submit a bill of particulars detailing counts against a compounding pharmacy owner accused of violating the Anti-Kickback Statute (AKS) because the allegations in the superseding indictment involve 491 prescriptions and do not adequately prepare the defendant with enough information to prepare for trial.

  • February 09, 2021

    Michigan Appeals Court Finds Federal Court Ruling Bars Provider’s No-Fault Suit

    ANN ARBOR, Mich. — An appeals court in Michigan on Feb. 4 affirmed a ruling awarding summary judgment to an insurer after finding that a medical provider’s suit seeking reimbursement for services provided to an individual injured in an automobile accident was barred by the doctrine of res judicata because a federal judge previously found that the insured’s policy should be rescinded and declared void ab initio based on a material misrepresentation in the policy application.

  • February 02, 2021

    Judge Reduces Sentence Of Former Drug Treatment Center Owner Due To COVID-19 Risks

    PHILADELPHIA — A federal judge in Pennsylvania on Feb. 1 granted a motion filed by the former owner of a drug treatment center who pleaded guilty to one count of conspiracy to commit health care fraud for a reduction of his 37-month prison sentence, finding that his health conditions place him at a higher risk of developing severe complications from COVID-19 and that he is being housed in a federal corrections institution (FCI) that has experienced the most COVID-19 infections at any federal facility in the country.

  • February 02, 2021

    Amicus Curiae Says District Court Erred In Instructing Jury In Insurance Bribery Suit

    RICHMOND, Va. — The National Association of Criminal Defense Lawyers on Jan. 28 filed an amicus curiae brief in the Fourth Circuit U.S. Court of Appeals, contending that a district court erred in instructing a jury on a disputed element of a charge in a $2 million bribery scheme case that resulted in convictions against a multinational insurance and reinsurance management company’s founder and a company consultant.

  • January 29, 2021

    Judge Reconsiders Default Ruling In Insurer’s RICO Suit Over Billing Scheme

    NEW YORK — A federal judge in New York on Jan. 21 reconsidered part of a Dec. 14 ruling that dismissed an insurance company’s lawsuit alleging 14 fraudulent billing schemes against a number of medical providers and clinics, finding that the default judgment should be entered against six retailers and their managers for schemes that they allegedly conducted and that the insurer must pay $2,010 in filing fees to remedy the improper joinder of the defendants.

  • January 28, 2021

    Magistrate Orders GEICO To Conduct ‘Full Overhaul’ Of Responses In Fraud Case

    BUFFALO, N.Y. — A federal magistrate judge in New York on Jan. 22 ordered Government Employees Insurance Co. (GEICO) and its affiliates to conduct a “full overhaul” of the interrogatory responses the insurer provided to two doctors and a medical practice accused of engaging in a scheme to submit fraudulent bills under the state’s no-fault insurance program, finding that the defendants should not be responsible for reviewing the insurer’s records to determine when the alleged scheme began and what claims were fraudulent.

  • January 27, 2021

    7th Circuit Finds No Error In Admitting Evidence Of Other Fires To Prove Scheme

    CHICAGO — The Seventh Circuit U.S. Court of Appeals on Jan. 22 affirmed a judge’s ruling allowing the government to admit evidence regarding other fires in a case brought against a man who was convicted on four counts of mail fraud for submitting claims to insurance companies for fires that were set to homes he owned, finding that evidence about fires that occurred in 2010 could show that he was engaged in a scheme and that information about a 2004 fire could demonstrate his modus operandi.