Mealey's Insurance Fraud
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November 15, 2018
5th Circuit Upholds Man’s Conviction For Role In Insurance Fraud Scheme
NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 14 affirmed a man’s convictions for charges of conspiracy to commit mail and wire fraud as part of a larger scheme to defraud insurance companies by filing claims for automobile accidents that never occurred, ruling that a federal judge in Texas did not err when denying his motion to vacate the sentence and hold an evidentiary hearing regarding whether the government threatened to charge his mother with perjury (United States v. Derrick L. Jimerson, No. 16-41262, 5th Cir., 2018 U.S. App. LEXIS 32218).
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November 15, 2018
Allstate Sues Chiropractors, Clinics Over Alleged Fraud Scheme
DETROIT — Allstate Insurance Co. and two of its affiliates on Nov. 8 sued two chiropractors and a number of clinics in a Michigan federal court, claiming that they engaged in a scheme to submit fraudulent bills for benefits under Michigan’s No-Fault Act that were medically unnecessary or not performed (Allstate Insurance Co., et al. v. Derek L. Bittner D.C., et al., No. 18-13484, E.D. Mich.).
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November 12, 2018
No Objection To Later Trial Date Over Charges Of Fraud On Crop Insurance
LEXINGTON, Ky. — The U.S. government in a Nov. 8 brief says it does not object to a farmer’s motion in a Kentucky federal court to continue trial to a later date over accusations that he submitted false reports regarding federally reinsured crop insurance policies but deferred to the court’s “sound judgment” (United States v. Christopher G. Hickerson, No. 18-cr-00111, E.D. Ky.).
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November 12, 2018
Panel: Some Cross-Claims From Lawyer Accused Of Insurance Fraud Properly Stricken
LOS ANGELES — A California appeals panel on Nov. 9 upheld a trial court judge’s ruling dismissing cross-claims brought by a lawyer accused of insurance fraud, finding that an insurance company’s subpoenas seeking the attorney’s deposition in three unrelated personal injury actions did not constitute an abuse of process under the state’s anti-SLAPP (strategic lawsuit against public participation) statute or constitute an unfair business practice in violation of California Business and Professions Code Section 17200 (Dennis Gerald Geselowitz v. Allstate Insurance Co., No. B278637, Calif. App., 2nd Dist., 3rd Div., 2018 Cal. App. Unpub. LEXIS 7605).
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November 12, 2018
Judge Denies Health Care Fraud Defendant’s Motion To Suppress Evidence From Emails
NEW YORK — A federal judge in New York on Nov. 9 denied a motion to suppress filed by a man accused of participating in a health care fraud scheme, finding that search warrants executed for three email accounts were not overbroad and that the man had no reasonable expectation of privacy for the accounts (United States v. Paul J. Mathieu, et al., No. 16 cr 763, S.D. N.Y., 2018 U.S. Dist. LEXIS 192281).
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November 7, 2018
Farmer Seeks Later Trial Date Over Charges Of Fraud On Crop Insurance
LEXINGTON, Ky. — Citing a “large volume of discovery,” a farmer accused by the U.S. government of submitting false reports regarding federally reinsured crop insurance policies on Nov. 2 asked a Kentucky federal court to continue trial to sometime after January (United States v. Christopher G. Hickerson, No. 18-cr-00111, E.D. Ky.).
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November 6, 2018
Ophthalmologist Agrees To Pay $2M For Fraudulently Billing Medicare, Medicaid
NEW YORK — An ophthalmologist and his practice on Nov. 1 agreed to pay $2 million to the federal government to resolve claims brought in New York federal court that he violated the False Claims Act (FCA) by submitting claims to Medicare and Medicaid for testing that was done so poorly that it lacked any diagnostic value (United States v. Metropolitan Retina Associates Inc., et al., No. 18-cv-9146, S.D. N.Y.).
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November 6, 2018
Farmer Charged With Fraud Scheme Against Federal Crop Reinsurer
LEXINGTON, Ky. — The U.S. government in a Nov. 1 indictment filed in a Kentucky federal court accuses a farmer of fraudulently submitting statements to a government agency that reinsures his crops (United States v. Keith Foley, No. 18-cr-00154, E.D. Ky.).
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November 2, 2018
Cardiologist Sentenced To 42 Months In Prison For Health Care Fraud
LONDON, Ky. — A federal judge in Kentucky on Nov. 1 sentenced a cardiologist to 42 months in prison and ordered him to pay a $50,000 fine and pay $257,515 in restitution to Medicare, Medicaid and private insurers after he was found guilty of health care fraud for implanting pacemakers in patients who did not need them (United States v. Anis Chalhoub, M.D., No. 16-cr-00023-GFHT-HAI, E.D. Ky.).
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November 1, 2018
Nurse Practitioner Convicted Of Health Care Fraud, Illegally Distributing Opioids
MONTGOMERY, Ala. — A federal judge in Alabama on Oct. 29 convicted a nurse practitioner on charges of health care fraud, conspiracy to commit health care fraud, conspiracy to unlawfully sell and distribute controlled substances and unlawfully selling and distributing controlled substances after finding that she falsified medical records to support services that were not provided and forged a physician’s signature to prescribe fentanyl, hydrocodone, oxycodone and alprazolam to patients (United States v. Lillian Akwuba, et al., No. 17-cr-511, M.D. Ala.).
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November 1, 2018
Agency Owners, Employees Convicted For Conducting $3.7M Medicare Fraud Scheme
DALLAS — Two owners of a home health care agency and two of its employees were convicted Oct. 29 by a federal jury in Texas for their roles in a $3.7 million fraud scheme involving the submission of claims to Medicare even though the owners had previously been excluded from participating in federal health care programs (United States v. Celestine Okwilagwe, et al., No. 16cr240, N.D. Texas).
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October 30, 2018
Judge Refuses To Suppress Evidence Of Fraud Scheme From Defendant’s Phone
DETROIT — Evidence from a defendant’s cell phone documenting his role in a scheme to fraudulently obtain unemployment insurance benefits should not be suppressed, a federal judge in Michigan ruled Oct. 29, finding that a private investigator for an insurance company was not acting as a government agent when viewing the contents of the phone (United States v. Damon Drekarr Kemp, No. 18-20043, E.D. Mich., 2018 U.S. Dist. LEXIS 184341).
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October 25, 2018
Magistrate Judge Denies Clinic’s Motion To Quash Insurer’s Subpoenas On Banks
NEWARK, N.J. — An insurer accusing a medical clinic of submitting fraudulent no-fault insurance claims can subpoena two banks the clinic does business with for records pertaining to accounts it holds because the information is relevant, a federal magistrate judge in New Jersey ruled Oct. 23 in denying the clinic’s motion to quash (Government Employees Insurance Co., et al. v. Stefan Trnovski, M.D., et al., No. 16-4662, D. N.J., 2018 U.S. Dist. LEXIS 182375).
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October 25, 2018
9th Circuit Panel Upholds Convictions For Making False Statements To Grand Jury
SAN FRANCISCO — A federal judge in California did not err when refusing to sever charges against two defendants accused of making false statements to a grand jury regarding their roles in a scheme to fraudulently obtain employment and disability insurance benefits, a Ninth Circuit U.S. Court of Appeals panel ruled Oct. 17, finding that the defendants were properly joined because the allegations stemmed from the same aspects of the alleged scheme and that there was sufficient evidence to support the convictions (United States v. Jasvir Kaur, et al., Nos. 17-10306, 17-10307, 9th Cir., 2018 U.S. App. LEXIS 29193).
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October 25, 2018
7th Circuit Upholds Dermatologist’s Conviction For Health Care Fraud
CHICAGO — A Seventh Circuit U.S. Court of Appeals panel on Oct. 17 overruled a dermatologist’s arguments that his conviction on eight counts of health care fraud and eight counts of making false statements affecting a health care matter should be vacated, finding that the evidence presented by the government supported the jury’s decision and that improper remarks made by the prosecution during closing arguments did not taint the verdict (United States v. Omeed Memar, No. 17-3098, 7th Cir., 2018 U.S. App. LEXIS 29165).
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October 24, 2018
Judge Refuses To Dismiss Suit Over ‘Upcoding’ Of Services To Insurer
PHILADELPHIA — A federal judge in Pennsylvania on Oct. 23 denied a motion to dismiss or transfer a lawsuit accusing a medical billing company of improperly upcoding services for neonatal intensive care to Aetna Inc. and its affiliates, finding that the insurer’s claims were timely and that its filing of a praecipe to issue a writ of summons in state court was sufficient to initiate action under the first-filed rule (Aetna Inc., et al. v. Mednax Inc., et al., No. 18-2217, E.D. Pa., 2018 U.S. Dist. LEXIS 181147).
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October 17, 2018
Judge Refuses To Reseal Documents In False Claims Act Suit Over Billing
PHILADELPHIA — A federal judge in Pennsylvania on Oct. 16 refused to reconsider a Sept. 5 decision to lift the seal on documents in a suit brought under the qui tam provisions of the False Claims Act against an insurer accused of submitting fraudulent bills to Medicare and ordered the government to decide within 30 days if it will intervene in the suit (United States of America, ex rel. Jean Brasher v. Pentech Health Inc., No. 13-05745, E.D. Pa., 2018 U.S. Dist. LEXIS 177118).
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October 17, 2018
Judge: Failure To Identify Vicious Dog Constituted Material Misrepresentation
RALEIGH, N.C. — A federal judge in North Carolina on Sept. 27 awarded summary judgment to an insurer, holding that a couple’s failure to disclose on their policy application that they owned an American Mastiff constituted a material misrepresentation that warranted the company’s refusal to provide coverage under a homeowner’s policy (United Property & Casualty Insurance Co. v. Jeffrey Surprenant, et al., No. 17-cv-96-FL, E.D. N.C., 2018 U.S. Dist. LEXIS 166240).
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October 17, 2018
Florida Doctor Charged With 26 Counts Of Health Care Fraud
FORT PIERCE, Fla. — A Florida gynecologist and obstetrician was charged with 26 counts of health care fraud for allegedly billing Medicare for $926,802 in services that were not provided, according to an indictment filed Oct. 4 in Florida federal court (United States of America v. Sheetal Kanar Kumar, No. 18cr14063, S.D. Fla.).
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October 16, 2018
Clinic Operators Charged With Running $8.5M Health Care Fraud Scheme
ATLANTA — The chief operating officer and the CEO of a medical clinic on Oct. 12 were charged in Georgia federal court with individual counts of conspiracy to commit health care fraud for their roles in a fraudulent billing scheme that resulted in private insurers paying $8.5 million for medical services that were never provided (United States of America v. Shailesh Kothari, et al., No. 18cr395, N.D. Ga.).