HOUSTON — A Texas man was sentenced by a federal judge to 80 years in prison for his role in a $13 million Medicare scheme and for filing false tax returns in 2013 and 2014, according to a docket entry filed Dec. 8 (United States of America v. Ebong Tilong, No. 15cr591, S.D. Texas).
BOWLING GREEN, Ky. — Evidence related to a man’s prior acts of setting fire to three residences and one automobile to collect insurance proceeds should be admitted during his trial on similar claims, a federal judge in Kentucky ruled Dec. 13, finding that the information has probative value as to whether he committed the act as part of a common scheme or plan (United States of America v. Steven Allen Pritchard, No. 16-CR-00028, W. D. Ky., 2017 U.S. Dist. LEXIS 204958).
MIAMI — A federal judge in Florida on Dec. 11 sentenced the former owner and operator of a health care agency to 115 months in prison and ordered him to pay $15.1 million in restitution for his role in a conspiracy to defraud Medicare (United States of America v. Yunesky Fornaris, No 17cr20163, S.D. Fla.).
ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Dec. 12 upheld a man’s conviction and sentence for his role in a health care fraud scheme, finding that the government presented “overwhelming evidence” to prove that he received illegal kickbacks and conspired with his co-defendants (United States of America v. Carlos Rodriguez Nerey, No. 16-13614, 11th Cir., 2017 U.S. App. LEXIS 25026).
SEATTLE — Finding insufficient support for an insurer’s claim that its consultants were engaged in advance of possible insurance fraud litigation, a Washington federal judge on Dec. 5 denied the insurer’s motion to quash subpoenas served on them by the plaintiff in a coverage suit related to extreme weather events (Premier Harvest LLC, et al. v. AXIS Surplus Insurance Co., et al., No. 2:17-cv-00784, W.D. Wash., 2017 U.S. Dist. LEXIS 199910).
LOS ANGELES — A California federal judge on Dec. 4 dismissed insureds’ claims for violation of California’s unfair competition law (UCL) and breach of contract, finding that they failed to show that an insurer’s termination of their life insurance policies was unreasonable (Arthur Avazian, et al. v. Genworth Life & Annuity Insurance Co., et al., No. 2:17-cv-06459, C.D. Calif., 2017 U.S. Dist. LEXIS 199067).
DETROIT — The owner of a home health agency that allegedly submitted $1.6 million in fraudulent claims to Medicare for services that were either medically unnecessary or not performed was found guilty by a federal jury in Michigan on Dec. 4 (United States of America v. Editha Manzano, et al., No. 16cr20593, E.D. Mich.).
CAMDEN, N.J. — A federal judge in New Jersey on Dec. 1 refused to dismiss a lawsuit brought by the Government Employees Insurance Co. (GEICO) over an alleged fraudulent billing scheme by doctors at two orthopedic firms, finding that the insurer’s claims under the Racketeer Influenced and Corrupt Organizations Act and the New Jersey Insurance Fraud Prevention Act (IFPA) are not subject to arbitration (Government Employees Insurance Company v. Regional Orthopedic Professional Association, et al., No. 17-1615, D. N.J., 2017 U.S. Dist. LEXIS 197599).
PHILADELPHIA — A 2-1 panel of the Pennsylvania Superior Court on Nov. 20 affirmed the dismissal of a grand jury’s indictment of a drapery sales company accused of being involved in an insurance fraud scheme, finding that the evidence presented by the state did not establish a prima facie case against the company (Commonwealth v. Richard Holston, No. 223 EDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4276).
NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 30 overturned a federal judge in Texas’ ruling ordering a physician’s assistant found guilty of conspiracy to commit insurance fraud to pay $4 million in restitution and forfeiture, holding that the man should be required to reimburse the government only for the proceeds he obtained from the scheme (United States of America v. Mansour Sanjar, et al., No. 15-20025, 5th Cir., 2017 U.S. App. LEXIS 24252).
JACKSON, Miss. — The operators of a Mississippi nursing home have agreed to pay the United States a total of $1.25 million to resolve allegations that they provided false claims to Medicare and the Mississippi Medicaid program related to the provision of “grossly substandard care” to residents, the U.S. Department of Justice announced Nov. 16. The same day, a Mississippi federal judge dismissed a relator’s second amended complaint and the United States’ complaint in intervention in the qui tam action after the parties stipulated to dismissal (United States, ex rel., Academy Health Center Inc. v. Hyperion Foundation Inc., et al., No. 10-00552, S.D. Miss.).
MIAMI — A federal judge in Florida on Nov. 8 sentenced a doctor to five years in prison and ordered him to pay $2.1 million in restitution for his role in an health care fraud and money-laundering scheme that involved the filing of fraudulent insurance claim forms and defrauding health care benefit programs (United States of America v. Kenneth Chatman, et al., No. 17cr80013, S.D. Fla.).
NEW ORLEANS — A federal judge in Louisiana on Nov. 8 found a woman guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks, two counts of health care fraud and five counts of accepting kickbacks for her role in a $3.2 million scheme that involved providing durable medical equipment to Medicare beneficiaries that was medically unnecessary (United States of America v. Tracy Richardson Brown, et al., No. 13-cr-243, E.D. La.).
MIAMI — State Farm Mutual Automobile Insurance Co. can pursue claims under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) against medical facilities accused of participating in a fraudulent billing scheme that caused the insurer to incur damages exceeding $3.8 million, a federal judge in Florida ruled Sept. 25, ruling that State Farm sufficiently stated claims for relief under the act (State Farm Mutual Automobile Insurance Company v. Performance Orthopaedics & Neurosurgery, LLC, et al., No. 17-cv-20028-KMM, S.D. Fla., 2017 U.S. Dist. LEXIS 156284).
GREENBELT, Md. — An intervening party in an insurance company’s lawsuit accusing an insured of making material misrepresentations on a policy application cannot amend its pleadings to change admissions and add counterclaims, a federal judge in Maryland ruled Nov. 13, finding that the request was untimely (CX Insurance Company v. Benjamin L. Kirson, No. 15-cv-3132, D. Md., 2017 U.S. Dist. LEXIS 187164).
DETROIT — A doctor was sentenced to 15 years in prison and ordered to pay $9.1 million in restitution by a federal judge in Michigan on Nov. 8 after being found guilty for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided (United States of America v. John Trotter II, et al., No. 14cr20273, E.D. Mich.).
PITTSBURGH — A woman was properly convicted for insurance fraud, forgery and theft of property, a Pennsylvania appeals panel ruled Nov. 7, finding that the woman’s presentation of a fabricated authorization letter for dental work constituted an attempt to defraud her insurance company (Commonwealth of Pennsylvania v. Amy Lee Palmer, No. 1039 WDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4117).
PHILADELPHIA — A Pennsylvania appeals panel on Nov. 7 overruled a woman’s argument that evidence presented during her insurance fraud trial did not support her conviction, holding that the state sufficiently showed an intent to defraud through her false statements to a state trooper during the investigation of a car fire (Commonwealth of Pennsylvania v. Ruth E. Gettel, No. 533 MDA 2017, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4101).
NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 7 upheld convictions of a man and his son who were accused of health care fraud and paying kickbacks to obtain business for their partial hospitalization programs (PHPs), ruling that evidence presented by the government was sufficient to support the jury’s verdict (United States of America v. Earnest Gibson III, et al., No. 15-20323, 5th Cir., 2017 U.S. Dist. LEXIS 22261).
NEW YORK — A federal judge in New York on Nov. 3 denied motions filed by two doctors seeking to sever their claims from a criminal insurance fraud indictment, finding that the defendants’ antagonistic defenses and the possibility of prejudicial spillover did not warrant severance (United States of America v. Asim Hameedi, et al., No. 17 Cr. 137, S.D. N.Y., 2017 U.S. Dist. LEXIS 182790).