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Mealey's Insurance Fraud

  • February 25, 2020

    GEICO’s Suit Against Clinics, Doctors Over Billing Survives Dismissal

    NEWARK, N.J. — A federal judge in New Jersey on Feb. 24 refused to dismiss a lawsuit brought by the Government Employees Insurance Co. and three of its affiliates against three clinics and employees accused of submitting $2.7 million in fraudulent bills for no-fault personal injury protection (PIP) benefits between 2013 and 2019, finding that the insurer sufficiently alleged claims for violations of the New Jersey Insurance Fraud Prevention Act (IFPA) and Racketeer Influenced and Corrupt Organizations (RICO) Act, fraud and unjust enrichment (Government Employees Insurance Co., et al. v. Adams Chiropractic Center P.C., et al., No. 19-20633, D. N.J., 2020 U.S. Dist. LEXIS 30753).

  • February 24, 2020

    1st Circuit Panel Affirms Doctor’s Health Care Fraud Conviction

    BOSTON — A First Circuit U.S. Court of Appeals panel on Feb. 20 upheld a doctor’s conviction on charges of making false statements in connection with health care benefits programs and conspiracy to make false statements, finding that a federal judge in Massachusetts did not err when denying the defendant’s motion to suppress e-mails that were obtained through a search warrant and when instructing the jury about a missing witness (United States v. Mousfafa Moataz Aboshady, No. 19-1232, 1st Cir., 2020 U.S. App. LEXIS 5198).

  • February 20, 2020

    DOJ:  Skilled Nursing Facilities Owners To Pay $15.4M Over False Billing

    PHILADELPHIA — The U.S. Department of Justice (DOJ) announced Feb. 19 that Guardian Elder Care Holdings Inc. and four of its related entities agreed to pay $15.4 million to resolve allegations that they violated the False Claims Act (FCA) when billing Medicare and another federal health benefits program for rehabilitation therapy services at their skilled nursing facilities that were medically unnecessary (United States, ex rel. Kraus v. Guardian Elder Care Holdings Inc., et al., No. 15-cv-6850, E.D. Pa.).

  • February 20, 2020

    10th Circuit Affirms Hospital’s Summary Judgment In Suit Over Billing

    DENVER — A 10th Circuit U.S. Court of Appeals panel on Feb. 7 upheld a hospital’s summary judgment award in a False Claims Act (FCA) suit accusing it of submitting fraudulent information regarding patients’ arrival times and its compliance with the Deficit Reduction Act of 2005 (DRA), holding that the plaintiff was unable to show that the alleged misrepresentations affected the government’s decision to pay the claims (United States, ex rel. Stacey L. Janssen v. Lawrence Memorial Hospital, No. 19-3011, 10th Cir., 2020 U.S. App. LEXIS 3809).

  • February 20, 2020

    GEICO Sues Windshield Replacement Company, Owners Over False Bills

    LOS ANGELES — The Government Employees Insurance Co. (GEICO) and three of its affiliates on Feb. 12 filed a lawsuit in California federal court accusing a windshield repair company and its owners of engaging in a fraudulent scheme to bill the insurer for expensive replacement windshields they never purchased and that they performed the work without a license to do so (Government Employees Insurance Co., et al. v. Winaffix Auto Glass Inc., et al., No. 20-cv-01401, C.D. Calif.).

  • February 18, 2020

    Michigan Panel Finds Failure To Mention 2017 Accident Was Material

    GRAND RAPIDS, Mich. — A Michigan appeals court panel on Feb. 11 affirmed a ruling awarding summary judgment to an insurer, finding that a man’s failure to mention a 2017 automobile accident as part of proceedings in a third lawsuit against the insurer seeking personal injury protection (PIP) benefits constituted a fraudulent insurance act under state law (Elijah Woody v. Auto Club Insurance Association, No. 346182, Mich. App., 2020 Mich. App. LEXIS 1042).

  • February 18, 2020

    7 Insys Execs Ordered To Pay $56.6M In Restitution For Subsys Opioid Scheme

    BOSTON — A Massachusetts federal judge on Feb. 14 ordered seven former high-ranking employees of opioid maker Insys Therapeutics Inc. to pay at least $56.68 million in restitution to Medicare, six health insurers and five individual victims of the defendants’ scheme to get insurers to pay for prescriptions of Subsys spray fentanyl for use by non-cancer patients (United States v. Michael L. Babich, et al., No. 16-cr-10343, D. Mass., 2020 U.S. Dist. LEXIS 25952).

  • February 14, 2020

    Magistrate Judge Refuses To Disqualify Insurer’s Law Firm In Fraud Suit

    NEW YORK — A federal magistrate judge in New York in Feb. 12 refused to disqualify attorneys and a law firm representing an insurer that is accusing a compounding pharmacy and its pharmacists of submitting claims for medically unnecessary medications, finding that there is not enough evidence to show that the attorneys and firm participated in the claims verification process (State Farm Mutual Automobile Insurance Co., et al. v. 21st Century Pharmacy Inc., et al., No. 17 Civ. 5845, E.D. N.Y., 2020 U.S. Dist. LEXIS 24646).

  • February 13, 2020

    Judge Dismisses Some Counts Against Theranos Executives In Fraud Case

    SAN JOSE, Calif. — A California federal judge on Feb. 11 granted a motion by Theranos Inc. founder Elizabeth A. Holmes and president Ramesh “Sunny” Balwani to dismiss fraud claims that relate to nonpaying patients and doctors, but denied dismissal of all other allegations related to the now-defunct blood-testing startup (United States v. Elizabeth A. Holmes, et al., No. 18-cr-258, N.D. Calif., San Jose Div., 2020 U.S. Dist. LEXIS 24551).

  • February 12, 2020

    Magistrate Judge: Insurer’s Counterclaims Over Billing Not Preempted By ERISA

    MIAMI — A federal magistrate judge in Florida on Feb. 3 recommended denying a plastic surgery office’s motion to dismiss counterclaims brought by an insurer that claims that the office submitted fraudulent bills to recover facility fees that it was not entitled to, holding that the insurer’s claims are not preempted by the Employee Retirement Income Security Act because it is not a fiduciary under the statute and that the counterclaims are not barred by the independent tort doctrine (Miami Beach Cosmetic and Plastic Surgery Center Inc. v. United Healthcare Insurance Co., No. 19-cv-23614, S.D. Fla., 2020 U.S. Dist. LEXIS 21456).

  • February 06, 2020

    4 Physicians Found Guilty Of Health Care Fraud Over Unnecessary Injections

    DETROIT — A federal jury in Michigan on Feb. 4 convicted four physicians on charges of health care fraud and conspiracy to commit health care fraud and wire fraud for their roles in a scheme to bill Medicare for medically unneeded back injections to patients who participated in exchange for prescriptions for unnecessary opioids (United States v. Mashiyat Rashid, et al., No. 17-cr-20465, E.D. Mich.).

  • February 06, 2020

    Doctor Sentenced To Probation For Fraudulently Prescribing Opioids To Himself

    JOHNSTOWN, Pa. — A federal judge in Pennsylvania on Feb. 4 sentenced a doctor to five years’ probation for billing Medicare for prescriptions for opioids written for his wife that he actually used himself after he pleaded guilty to one count of health care fraud (United States v. David J. Girardi, No. 19-cr-12, W.D. Pa.).

  • February 03, 2020

    Material Misrepresentation Warrants Summary Judgment In Insurer’s Favor, Panel Says

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Jan. 31 affirmed a lower federal court’s summary judgment ruling in favor of a commercial property insurer in an insured’s breach of contract lawsuit arising from its vandalism claims, finding that the insured made material misrepresentations that contractually relieved the insurer of any potential duty to pay for the claims (American Land Investment Ltd. v. Allstate Insurance Company, et al., No. 19-3317, 6th Cir., 2020 U.S. App. LEXIS 3095).

  • January 31, 2020

    State High Court Permanently Disbars Lawyer Who Pleaded Guilty To Medicare Fraud

    NEW ORLEANS — A Louisiana Supreme Court panel on Jan. 14 permanently disbarred an attorney after she pleaded guilty to participating in a health care fraud scheme that resulted in the insurer’s payment of $575,450.07 in false claims (In re:  Louella P. Givens-Harding, No. 2019-B-01514, La. Sup., 2020 La. LEXIS 150).

  • January 31, 2020

    Nonparty Doctor’s Objections To Recommendation To Enforce Subpoena Overruled

    MIAMI — A federal judge in Florida on Jan. 30 overruled a nonparty doctor’s objections to a magistrate judge’s Dec. 20 report and recommendation to grant State Farm Mutual Automobile Insurance Co.’s motion to enforce a subpoena, finding that personal service is not required and that the requested information is relevant (State Farm Mutual Automobile Insurance Co. v. Vladimir Maistrenko, No. 19-MC-20850-SCOLA-TORRES, S.D. Fla., 2020 U.S. Dist. LEXIS 15285).

  • January 23, 2020

    Psychiatrist Sentenced To 27 Months In Prison For Fraudulent Billing Scheme

    NORFOLK, Va. — A psychiatrist was sentenced to 27 months in prison and ordered to pay $465,942 in restitution by a federal judge in Virginia on Jan. 16 after the defendant pleaded guilty in September to one count of health care fraud for submitting false bills to Medicare, Medicaid and other insurers (United States v. Udaya Shetty, No. 19-cr-89, E.D. Va.).

  • January 23, 2020

    DOJ: Doctor Agrees To Pay $1.1M For Services Provided To Elderly Patients

    NEW YORK — An otolaryngologist on Dec. 19 entered into an agreement with the federal government to pay $1.1 million to resolve allegations that he violated the False Claims Act when paying kickbacks and submitting fraudulent claims for medically unnecessary allergy tests and other services, the U.S. Department of Justice (DOJ) announced Jan. 20.

  • January 22, 2020

    Doctor Sentenced For Making False Statements Over Treatment Of Elderly Patients

    CEDAR RAPIDS, Iowa — A federal judge in Iowa on Jan. 17 sentenced a doctor to two months in prison and ordered him to pay $117,199.32 in restitution after he pleaded guilty to making false statements to federal investigators over his upcoding of claims he submitted to Medicare and Medicaid for the treatment of patients in nursing homes (United States v. Joseph X. Latella, No. 19cr3030, N.D. Iowa).

  • January 21, 2020

    Pharmacy, Owners, To Appeal Ruling Barring Future Collection Suits Against GEICO

    NEW YORK — A pharmacy and its two owners filed a notice of appeal in New York federal court on Jan. 17, stating that they will ask the Second Circuit U.S. Court of Appeals to review a federal judge’s Jan. 16 ruling that stayed pending collection arbitration actions and barred the filing of any future state court collection actions against an insurer that is accusing them of submitting claims under New York’s no-fault law for medically unnecessary pain medications (Government Employees Insurance Co., et al. v. Wellmart RX Inc., et al., No. 19-CV-04414, E.D. N.Y.).

  • January 21, 2020

    2nd Circuit Upholds Man’s Conviction, Sentence For Role In STOLI Policy Scheme

    NEW YORK — A Second Circuit U.S. Court of Appeals panel on Jan. 13 affirmed a man’s conviction and 30-month prison sentence for a scheme involving stranger-obtained life insurance (STOLI) policies, finding that a federal judge in Connecticut did not err by refusing to suppress evidence from search warrants and that decisions extending time to the defendant did not violate the Speedy Trial Act (United States v. Wayne Bursey, et al., No. 19-70-cr, 2nd Cir., 2020 U.S. App. LEXIS 1350).