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).
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).
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).
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).
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).
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).
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.).
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.).
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).
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.).
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).
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.).
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).
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).
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.).
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).
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.).
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.).
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).
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).