Mealey's Insurance Fraud

  • May 21, 2020

    Judge Dismisses Suit, Says Off-Label Marketing Violated False Claims Act

    WASHINGTON, D.C. — A federal judge in the District of Columbia on May 19 dismissed without prejudice a relator’s False Claims Act (FCA) lawsuit saying Vanda Pharmaceuticals Inc.’s off-label promotion of an atypical antipsychotic and a drug used to treat 24-hour non-sleep disorder in blind patients resulted in the submission of fraudulent claims to Medicare and Medicaid (United States, ex rel. Richard Gardner v. Vanda Pharmaceuticals Inc., No. 17-cv-00464, D. D.C., 2020 U.S. Dist. LEXIS 87790).

  • May 19, 2020

    Judge:  Fraud Defendant’s Evidence Regarding Legitimate Therapy Services Irrelevant

    NEW YORK — A federal judge in New York on May 15 granted the federal government’s motion in limine to preclude a woman accused of health care fraud from presenting evidence during a trial demonstrating that she had performed legitimate therapy sessions with developmentally challenged children, finding that the information is irrelevant (United States v. Marina Golfo, No. 19-cv-00095, E.D. N.Y., 2020 U.S. Dist. LEXIS 85377).

  • May 18, 2020

    5th Circuit Panel Upholds Convictions, Sentences In $3.5M Medicare Fraud Scheme

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on May 15 affirmed the convictions of two participants in a $3.5 million Medicare fraud scheme stemming from the operation of a home health care services company for elderly patients, as well as the sentences of the two remaining participants, holding that the evidence was sufficient to support the convictions and that the sentences were proper (United States v. Paul Emordi, et al., No. 19-10400, 5th Cir., 2020 U.S. App. LEXIS 15567).

  • May 15, 2020

    Idaho Panel:  Restitution Amount Properly Included Insurer’s Investigation Costs

    BOISE, Idaho — An Idaho appeals panel on May 13 upheld a trial judge’s ruling ordering a woman convicted of insurance fraud to pay $2,400.60 in restitution to her insurance company, holding that the judge did not err when finding that the insurer’s investigation and travel costs should be included in the amount (Idaho v. Zoe Renee Barham, No. 47241, Idaho App., 2020 Ida. App. LEXIS 45).

  • May 15, 2020

    COVID-19 Not A Compelling Reason To Release Insurance Fraud Defendant, Judge Says

    PHILADELPHIA — A federal judge in Pennsylvania on May 12 denied a request for bail filed by a man accused of setting fire to a building as part of an insurance fraud scheme, holding that the COVID-19 pandemic does not provide a compelling reason to release him, that he is a flight risk and that he poses a danger to the community (United States v. Imad Dawara, No. 19-414-1, E.D. Pa., 2020 U.S. Dist. LEXIS 83126).

  • May 14, 2020

    Judge Denies Doctors’ New Trial Request Following False Claims Act Verdict

    CAPE GIRARDEAU, Mo. — A federal judge in Missouri on April 15 denied a motion for new trial and/or judgment as a matter of law filed by two doctors and their practices after a jury found that the defendants conspired to violate the False Claims Act (FCA) as part of a kickback scheme involving spinal surgeries, ruling that the defendants’ challenges to the jury instructions should have been raised during the trial (United States ex rel. Paul Cairns v. D.S. Medical LLC, et al., No. 12CV004, E.D. Mo., 2020 U.S. Dist. LEXIS 66323).

  • May 14, 2020

    Man Pleads Guilty To Role In $4.6M Scheme Involving Kickbacks For Genetic Testing

    NEWARK, N.J. — A Florida man pleaded guilty to counts of conspiracy to commit health care fraud and conspiracy to receive kickbacks in federal court in New Jersey on May 6 for his role in a scheme that resulted in Medicare paying $4.6 million for unnecessary genetic testing that was ordered by a doctor who was not licensed to practice medicine in the state (United States v. Matthew S. Ellis, et al., No. 19cr693, D. N.J.).

  • May 14, 2020

    AIG Subsidiary Alleges Reinsurance Scheme With Use Of Counterfeit Policies

    LOUISVILLE, Ky. — An American International Group Inc. (AIG) subsidiary filed a complaint on May 11 in a Kentucky federal court alleging a captive reinsurance scheme involving a trademark infringement of its mark on counterfeit insurance policies and an attempt to defraud the public (Lexington Insurance Company v. The Ambassador Group LLC, et al., No. 20-cv-330, W.D. Ky.).

  • May 12, 2020

    Woman’s Misrepresentation About Employment Bars Claim For Benefits, Panel Says

    GRAND RAPIDS, Mich. — A Michigan appeals panel on May 7 overturned a trial court judge’s denial of an insurance company’s motion for summary judgment, finding that the insurer is not required to pay personal injury protection (PIP) benefits on a woman’s claim because she made fraudulent statements about working at the International House of Pancakes (IHOP) at the time of the accident, about the amount she was paid and about how long her shifts were (Daisian Wright v. Farm Bureau General Insurance Co. of Michigan, No. 347112, Mich. App., 2020 Mich. App. LEXIS 3250).

  • May 11, 2020

    Doctor Charged For Fraudulently Billing For Purported COVID-19 Treatments

    DETROIT — A doctor was charged with counts of health care fraud and conspiracy to commit health care fraud in a criminal complaint filed in federal court in Michigan on April 24 for fraudulently billing Medicare and private insurers for treating patients with high-dose vitamin C injections to treat and prevent the contraction of COVID-19 (United States v. Charles Mok, No. 20cr, E.D. Mich.).

  • May 07, 2020

    Magistrate Judge Says Insurer Can Have Access To Windshield Installer’s Ledger

    TAMPA, Fla. — A federal magistrate judge in Florida on May 5 granted in part an insurer’s motion to compel seeking financial records, tax returns and the general ledger of a windshield company accused of submitting false claims for replacement, holding that while the insurance company can have access to the ledger, more discovery is needed to determine if it should be allowed to have copies of the tax returns and other financial information (Government Employees Insurance Co., et al. v. Sean Martineau, et al., No. 19-cv-1382-T-35SPF, M.D. Fla., 2020 U.S. Dist. LEXIS 78816).

  • May 06, 2020

    Insolvent Insurer’s Directors Seek Dismissal Of Breach Of Fiduciary Duty Case

    BATON ROUGE, La. — An insolvent insurer’s directors and officers filed motions on April 30 asking a Louisiana federal court to dismiss a rehabilitator’s breach of fiduciary duty lawsuit alleging that they intentionally misled state insurance regulators on the insurer’s true financial condition (James J. Donelon v. Jeffrey C. Pollick, et al., No. 20-177, M.D. La.).

  • May 06, 2020

    Judge Finds Counsel Was Effective, Refuses To Amend Insurance Fraud Sentence

    AIKEN, S.C. — An attorney for a man who pleaded guilty to participating in a scheme to submit applications for life insurance policies that included false information about the individual’s income, health and mortgage information acted effectively when representing him because the attorney was not required to cite cases from beyond the Fourth Circuit U.S. Court of Appeals, a federal judge in South Carolina ruled May 1 in denying the defendant’s motion to vacate his five-year prison sentence (United States v. Douglas Wade Williamson, No. 17-cr-987-JMC-11, D. S.C., 2020 U.S. Dist. LEXIS 77627).

  • May 05, 2020

    Trial Court Properly Considered Extrinsic Evidence In Fraud, Auto Suit

    AUSTIN, Texas — The Texas Supreme Court on May 1 reversed an appeals court’s ruling and reinstated a trial court’s ruling in favor of an insurer after determining that the trial court correctly considered extrinsic evidence when it concluded that an insured and a third party suing the insured colluded to make false representations in an underlying suit arising out of an auto accident (Loya Insurance Co. v. Osbalto Hurtado Avalos, et al., No. 18-0837, Texas Sup.,  2020 Tex. LEXIS 373).

  • April 30, 2020

    Diagnostics Company To Pay Up To $43M Over False Claims Allegations

    ASHEVILLE, N.C. — A clinical laboratory services company entered into an agreement in federal court in North Carolina to pay up to $43 million to resolve claims brought by a whistleblower doctor, the federal government and the state in a False Claims Act (FCA) suit alleging that it submitted fraudulent bills for tests that were not medically necessary, according to April 27 court filings (United States, ex rel. Daryl Landis v. Genova Diagnostics Inc., No. 17-341, W.D. N.C.).

  • April 29, 2020

    Judge Upholds Doctor’s Conviction For Health Care Fraud, Denies New Trial

    CHICAGO — A federal judge in Illinois on April 28 denied a doctor’s motion for acquittal and/or new trial, holding that the evidence presented by the government sufficiently supported his convictions for a fraudulent billing scheme involving manipulations under anesthesia (MUA) (United States v. Paul Madison, No. 12-cr-1004-1, N.D. Ill., 2020 U.S. Dist. LEXIS 74230).

  • April 28, 2020

    Man Ordered To Pay $3.4M, Serve 15 Months For Unnecessary Urine Tests

    PHILADELPHIA — A federal judge in Pennsylvania on April 24 sentenced a Florida man to 15 months plus one day in prison and ordered him to pay $3.4 million in restitution after he pleaded guilty to participating in a scheme involving the payment of kickbacks for medically unnecessary urine tests for patients receiving treatment at a drug and alcohol rehabilitation facility, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced (United States v. Jesse Peters, No. 19cr174, E.D. Pa.).

  • April 27, 2020

    Insurer’s Rehabilitator: Insurance Fraud Suit Should Be Remanded

    BATON ROUGE, La. — An insolvent insurer’s rehabilitator in an April 23 memorandum asks a Louisiana federal court to remand a suit against the insurer’s various directors and officers, banks and a loan officer over allegations that they intentionally misled state insurance regulators on the insurer’s true financial condition (James J. Donelon v. Jeffrey C. Pollick, et al., No. 20-177, M.D. La.).

  • April 24, 2020

    3rd Circuit Finds Scam Leader’s Sentence Properly Enhanced For Targeting Seniors

    PHILADELPHIA — A Third Circuit U.S. Court of Appeals panel on April 22 affirmed a man’s 50-month sentence for conspiracy to commit health care fraud, finding that a federal judge in New Jersey did not err when enhancing the defendant’s sentence because the scheme targeted elderly patients and used a charitable organization as a pretense and because he was a leader of the plan (United States v. Seth Rehfuss, No. 19-2166, 3rd Cir., 2020 U.S. App. LEXIS 12915).

  • April 23, 2020

    Fraudulent Misrepresentation Counterclaim Against Insurers Dismissed By Judge

    DETROIT — Medical providers cannot pursue a counterclaim for fraudulent misrepresentation against two insurers, a federal judge in Michigan ruled April 21, holding that the assignments of claims signed by insureds did not give the providers the right to assert tort claims against the companies (Liberty Mutual Fire Insurance Co., et al. v. Michael Angelo, et al., No. 19-12051, E.D. Mich., 2020 U.S. Dist. LEXIS 70075).