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Mealey's Insurance Fraud

  • January 22, 2019

    Judge Dismisses Parts Of Women’s False Claims Act Suit Over Laboratory’s Billing

    BEAUFORT, S.C. — A federal judge in South Carolina on Jan. 16 dismissed portions of a False Claims Act (FCA) suit brought by two women accusing Laboratory Corporation of America Holdings Corp. (LabCorp) of submitting claims to Medicare for unnecessary testing, reverse false claims and violations of the California Insurance Frauds Prevention Act (CIFPA) and Illinois Insurance Claims Fraud Prevention Act (ICFPA), finding that the plaintiffs failed to sufficiently state claims under Federal Rule of Civil Procedure 12(b)(6) (United States, ex rel. Scarlett Lutz, et al. v. Laboratory Corporation of America Holdings Corp., No. 14-cv-3699-RMG, D. S.C., 2019 U.S. Dist. LEXIS 7486).

  • January 22, 2019

    Judge Allows Plaintiffs In Legal Malpractice Suit To Intervene In Insurer’s Action

    FLORENCE, S.C. — Plaintiffs in a state court legal malpractice lawsuit against a lawyer and his firm can intervene in a suit brought by an insurance company seeking to rescind a professional liability policy issued to the firm over alleged misrepresentations on the policy application, a federal judge in South Carolina ruled Jan. 17, holding that the intervenors satisfied the four criteria of Federal Rule of Civil Procedure 24(a)(2) (Maxum Indemnity Co. v. Biddle Law Firm P.A., et al., No. 18-cv-00742-RBH, D. S.C., 2019 U.S. Dist. LEXIS 8219).

  • January 17, 2019

    Judge: No Hearing Needed For Venue In Suit Over Fraudulent Prescriptions

    LOUISVILLE, Ky.— A federal judge in Kentucky on Jan. 15 denied a motion for an evidentiary hearing filed by a pharmacy owner and a pharmacist accused of illegally writing prescriptions for tramadol and fraudulently billing an insurance company, finding that the court had previously addressed the issue in ruling on a motion for dismissal and that factual disputes prevent a ruling on whether the venue is proper (United States v. Philip E. Michael II, et al., No. 16-cr-00101-RGJ, W.D. Ky., 2019 U.S. Dist. LEXIS 6791).

  • January 17, 2019

    Magistrate Judge Says Clinic Operator Should Pay GEICO $4M For False Claims

    NEW YORK — A federal magistrate judge in New York on Dec. 18 recommended entering a $4 million default judgment against the operator of two clinics that allegedly submitted $2.6 million in false claims to the Government Employees Insurance Co. (GEICO) and its subsidiaries, finding that the insurer sufficiently alleged that the operator engaged in fraud, unjust enrichment and violation of the Racketeer Influenced and Corrupt Organizations Act (Government Employees Insurance Co., et al. v. Azu Ajudua, M.D., No. 15-cv-5199, E.D. N.Y., 2018 U.S. Dist. LEXIS 213930).

  • January 17, 2019

    Man Waived Challenge To Evidence Of Arson, Fraud, Panel Rules

    HARRISBURG, Pa. — A Pennsylvania Superior Court panel on Dec. 24 overruled a man’s challenges to the sufficiency of evidence presented during a trial on allegations that he committed reckless burning, aggravated arson and insurance fraud, finding that deficiencies in his brief resulted in a waiver of his arguments (Pennsylvania v. Steven Michael Krcelich, No. 959 WDA 2018, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 4792).

  • January 17, 2019

    Man’s Convictions For Wire Fraud, Witness Tampering, Upheld By 4th Circuit

    RICHMOND, Va. — A Fourth Circuit U.S. Court of Appeals panel on Jan. 14 affirmed a man’s convictions for witness tampering and conspiracy to commit wire fraud as part of a scheme in which he and others fraudulently obtained insurance policies for homes and cars and then submitted claims after setting them on fire, holding that the evidence presented by the government supported the jury’s decision (United States v. Verndon Taylor, No. 18-4041, 4th Cir., 2019 U.S. App. LEXIS 1187).

  • January 16, 2019

    Judge Finds Counsel Effectively Represented Insurance Fraud Defendant

    CHICAGO — A federal judge in Illinois on Dec. 20 denied a man’s request to vacate his 75-month sentence for health care fraud, finding that the attorneys that represented him during plea negotiations and sentencing acted effectively (Ankur Roy v. United States, No. 17 C 5217, N.D. Ill., 2018 U.S. Dist. LEXIS 215539).

  • January 16, 2019

    Judge Finds Delay For Health Care Fraud Trial Excusable

    DETROIT — A federal judge in Michigan on Jan. 14 approved a stipulation between the federal government and six doctors accused of health care fraud for writing prescriptions for opioids that were not medically necessary that set a trial date of July 9, finding that the parties agreed that the “ends of justice served by granting the requested continuance outweigh the best interests of the public and the defendants in a speedy trial” (United States v. Dr. Rajendra Bothra, et al., No. 18-cr-20800, E.D. Mich.).

  • January 15, 2019

    Cardiologist’s Request For Release Pending Appeal Of Fraud Conviction Denied

    LONDON, Ky. — A federal judge in Kentucky on Dec. 20 denied a request for release pending appeal filed by a cardiologist that was convicted of health care fraud for implanting pacemakers in patients who did not need them and sentenced to 42 months in prison, finding that the doctor failed to adequately argue that the conviction would be likely be overturned (United States v. Anis Chalhoub, M.D., No. 16-cr-00023-GFHT-HAI, E.D. Ky., 2018 U.S. Dist. LEXIS 215680).

  • January 14, 2019

    Pennsylvania Panel Finds Evidence Supported Man’s Arson, Fraud Convictions

    HARRISBURG, Pa. — A Pennsylvania appeals panel on Jan. 11 affirmed a man’s convictions for arson and insurance fraud, holding that the evidence presented to the jury sufficiently supported its decision (Commonwealth v. Jamat Ali Manzoor, No. 1121 MDA 2017, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 105).

  • January 11, 2019

    Michigan Panel Upholds Insurer’s Summary Judgment Award Over Misrepresentations

    DETROIT— A Michigan appeals court panel on Jan. 8 upheld Allstate Insurance Co.’s summary judgment award in a case brought by a man who sought personal injury protection (PIP) coverage for injuries that he sustained after he was struck by a vehicle while on his bicycle, finding that the man made fraudulent misrepresentations to the company that warranted a denial of coverage (Emmanuel McCune Jr., et al. v. Allstate Insurance Co., No. 340476, Mich. App., 2019 Mich. App. LEXIS 27).

  • December 20, 2018

    Judge Orders Hearing On Continuance Of Trial In False Insurance Claims Case

    LEXINGTON, Ky. — A Kentucky federal judge on Dec. 17 ordered a hearing to address whether he should again continue a jury trial in a lawsuit alleging that farmers defrauded the United States through the filing of false insurance claims reimbursed by the U.S. Department of Agriculture (USDA) and by making false statements and reports in connection with the federally reinsured crop insurance program (United States v. Bradley Price, et al., No. 18-cr-60, E.D. Ky.).

  • December 18, 2018

    9th Circuit Finds Woman Waived Right To Appeal Insurance Fraud Guilty Plea

    SEATTLE — A Ninth Circuit U.S. Court of Appeals panel on Dec. 14 dismissed a woman’s appeal challenging her guilty plea to 24 counts of health care fraud and aggravated identity theft for billing insurance companies for dental hygiene care that she was not authorized to provide because she stated that she understood the consequences of her plea (United States v. Cherie Renee Dillon, Nos. 17-30122, 17-30235, 9th Cir., 2018 U.S. App. LEXIS 35206).

  • December 13, 2018

    Judge Enjoins Pending, Future Arbitration Proceedings Over No-Fault Claims

    NEW YORK — A federal judge in New York on Nov. 16 granted a request by the Government Employees Insurance Co. (GEICO) and its affiliates to enjoin pending and future arbitration proceedings brought by an acupuncturist, a clinic administrator and a couple accusing the insurer of failing to pay claims submitted under New York’s No-Fault Insurance Law, finding that any rulings against the insurer during the pendency of its declaratory judgment suit would result in undue harm (Government Employees Insurance Co., et al. v. Igor Mayzenberg, et al., No. 17-cv-2802, E.D. N.Y., 2018 U.S. Dist. LEXIS 195890).

  • December 13, 2018

    Judge Dismisses State Farm’s Suit Accusing Chiropractors, Clinics Of Fraud

    GREENBELT, Md.— A lawsuit filed by State Farm Mutual Automobile Insurance Co. and State Farm Fire & Casualty Co. (collectively State Farm) accusing two chiropractic clinics and their doctors of submitting fraudulent claims was dismissed by a federal judge in Maryland on Dec. 11 after the judge found that the insurer’s lawsuit failed to distinguish whether the defendants were falsifying patients’ medical records or sending bills for treatment that was medically unnecessary (State Farm Mutual Automobile Insurance Co., et al. v. Carefree Land Chiropractic LLC, et al., No. 18-cv-1279, D. Md., 2018 U.S. Dist. LEXIS 209114)

  • December 13, 2018

    Senior Living Center Asks High Court To Review Ruling In Billing Suit

    WASHINGTON, D.C. — A senior living center petitioned the U.S. Supreme Court on Nov. 20, seeking review of a Sixth Circuit U.S. Court of Appeals ruling reinstating a former employee’s False Claims Act suit, arguing that a divided appellate panel erred in finding that the woman’s allegations satisfied the statute’s requirements for materiality and scienter (Brookdale Senior Living Communities Inc., et al. v. United States of America, ex rel. Marjorie Prather, No. 18-699, U.S. Sup.).

  • December 12, 2018

    Judge Did No Err When Denying Clinic Operator’s Guilty Plea, Panel Says

    CHICAGO — A panel of the Seventh Circuit U.S. Court of Appeals on Nov. 29 affirmed a federal judge in Illinois’ decision to deny a chiropractic clinic owner’s request to withdraw his plea of guilty to one count of health care fraud, finding that he could not raise an ineffective assistance of counsel argument and because he was not entitled to a hearing pursuant to the rulings in Kastigar v. United States, 406 U.S. 441, 92 S. Ct. 1653, 32 L. Ed. 2d 212 (1972) and United States v. Palumbo, 897 F.2d 245 (7th Cir. 1990) (United States v. Steven Paul, No. 17-3606, 7th Cir., 2018 U.S. App. LEXIS 33485).

  • December 12, 2018

    6th Circuit Affirms Doctor’s 19-Year Sentence, Finds Counsel Acted Effectively

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Nov. 26 affirmed a doctor’s 19-year prison sentence for conspiracy to commit health care fraud and conspiracy to distribute and possess with intent to distribute controlled substances, holding that his counsel did not commit a prejudicial error when failing to present evidence that he was in a coma for two months during 2012 and unable to allegedly prescribe the drugs illegally (United States v. Adelfo Pamatmat, No. 17-1611, 6th Cir., 2018 U.S. App. LEXIS 33113).

  • December 12, 2018

    California Appeals Panel Finds Man’s Guilty Plea To Fraud Claim Valid

    SAN FRANCISCO — A California appellate panel on Nov. 29 upheld a man’s sentence of one year in prison and restitution of $10,000 after pleading guilty to one count of insurance fraud, finding that he failed to obtain a probable cause certificate from the trial court (People v. Glenn Josue Barrera-Izaba, No. A151037, Calif. App., 1st Dist., 5th Div., 2018 Cal. App. Unpub. LEXIS 8054).

  • December 12, 2018

    3 Indicted In Scheme To Pay Kickbacks For Compounded Drug Prescriptions

    TULSA, Okla. — The owner of a number of pharmacies and two physicians were indicted in Oklahoma federal court on Dec. 7 for engaging in a scheme involving the payment of illegal kickbacks to physicians who submitted prescriptions for compounded drugs that were later billed to federal health care programs and private insurers for reimbursement (United States v. Christopher P. Parks, et al., No. 18cr251, N.D. Okla.).