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Mealey's Insurance Fraud

  • November 15, 2019

    Insurer’s Fraud Suit Remanded After Judge Finds No Preemption By ERISA

    SANTA ANA, Calif. — An insurer’s lawsuit accusing a number of substance abuse treatment centers of common-law fraud, violation of California’ unfair competition law (UCL) and other claims can proceed in state court, a federal judge in California ruled Nov. 13, holding that the plaintiff company’s claims are not preempted by the Employee Retirement and Income Security Act (Health Net Life Insurance Co. v. Morningside Recovery LLC, et al., No. 19-cv-1342, C.D. Calif., 2019 U.S. Dist. LEXIS 197937).

  • November 14, 2019

    Panel:  Counsel’s Failure To Raise Youth Factors Argument Was Not Ineffective

    SAN FRANCISCO — A trial attorney’s failure to raise the youth factors argument in two U.S. Supreme Court rulings and one California Supreme Court case following a man’s conviction on two counts of insurance fraud did not constitute ineffective assistance of counsel, a California appeals panel ruled Nov. 13, finding that the contents of the presentence report prepared by the prosecution showed the defendant’s history of failing to comply with probation and post-sentence requirements (People v. Lamont James, Nos. A155627, A157772, Calif. App., 1st Dist., 2nd Div., 2019 Cal. App. Unpub. LEXIS 7507).

  • November 14, 2019

    Marketing Company, Owner Indicted For Scheme To Defraud Elderly Patients

    AUGUSTA, Ga. — A man and his marketing company were indicted in federal court in Georgia on Nov. 7 for engaging in a scheme in which they paid illegal kickbacks to workers who solicited elderly patients for medically unnecessary genetic testing that was then fraudulently billed to Medicare (United States v. Patrick Siado, et al., No. 19-cr-149, S.D. Ga.).

  • November 13, 2019

    U.S. Attorney Says Kentucky Doctor To Pay Penalty For Illegal Kickbacks

    TULSA, Okla. — The U.S. Attorney’s Office for the Northern District of Oklahoma said in a Nov. 8 press release that a Kentucky podiatrist agreed to pay $65,404 for paying illegal kickbacks to a compounding pharmacy in violation of the False Claims Act (FCA).

  • November 12, 2019

    Man’s Challenges To Convictions For Role In Fraud Scheme Overruled By Judge

    NEW YORK — A federal judge in New York on Nov. 7 denied a man’s motions for a judgment of acquittal and new trial, finding that evidence presented by the government sufficiently supported a jury’s finding that he engaged in conspiracy and mail fraud as part of a slip-and-fall insurance fraud scheme (United States v. Bryan Duncan, et al., No. 18-cr-289, S.D. N.Y., 2019 U.S. Dist. LEXIS 193839).

  • November 11, 2019

    Admission Of Evidence Of Prior Injury Does Not Warrant Vacating Fraud Verdict

    SANTA ANA, Calif. — A California appeals court panel on Nov. 8 found that while a trial court judge’s decision to admit evidence regarding a 2009 incident in which a police officer injured his right hand while on duty was erroneous, it does not warrant vacating the officer’s conviction for insurance fraud because the error was not prejudicial (People v. Ryan Patrick Natividad, No. G055248, Calif. App., 4th Dist., 3rd Div., 2019 Cal. App. Unpub. LEXIS 7451).

  • November 08, 2019

    Man’s Conviction For Disability Insurance Fraud Upheld By Judge

    MISSOULA, Mont. — The federal government presented sufficient evidence showing that a man intentionally misrepresented to the Social Security Administration that his health was improving to continue to receive disability benefits, a federal judge in Montana ruled Nov. 5 in denying a man’s motion for acquittal or new trial (United States v. John Cicero Hughes, No. CR 18-38-M-DLC, D. Mont., 2019 U.S. Dist. LEXIS 192130).

  • November 01, 2019

    Judge Finds No Jurisdiction Over Ambulatory Services Provider Accused Of Fraud

    NEW YORK — A federal judge in New York on Oct. 25 dismissed a lawsuit brought by Allstate Insurance Co. and its affiliates against a New Jersey ambulatory services provider accused of submitting fraudulent bills for reimbursement under New York’s no-fault insurance law, holding that the fact that New York residents were treated at the facility and that bills were sent to the insurer’s New York office does not provide the basis for jurisdiction (Allstate Insurance Co., et al. v. Sangwoo Mah, et al., No. 19-cv-2866, E.D. N.Y., 2019 U.S. Dist. LEXIS 185748).

  • November 01, 2019

    Rheumatologist Given 37-Month Prison Sentence For Fraudulent Billing

    NEW HAVEN, Conn. — A federal judge in Connecticut on Oct. 30 sentenced a rheumatologist to 37 months in prison followed by two years of supervised release and ordered him to pay $894,789 in restitution after he pleaded guilty to fraudulently billing Connecticut Medicaid for the rheumatoid arthritis medication Remicade (United States v. Crispin Abarientos, No. 19cr171, D. Conn.).

  • October 31, 2019

    Judge Adopts Ruling To Deny Transfer Of Health Care Fraud Suit

    GREENEVILLE, Tenn. — A federal judge in Tennessee on Oct. 22 adopted a magistrate judge’s order to deny transfer of a criminal action brought by the federal government against individuals who deceived patients and doctors into requesting prescription medications and pharmacies that misrepresented the purchase prices of the drugs, finding that the case should remain in Tennessee because a majority of the counts against the defendants involve the use of the U.S. mail in Tennessee (United States v. Andrew Assad, et al., No. 18-cr-140, E.D. Tenn., 2019 U.S. Dist. LEXIS 182170).

  • October 30, 2019

    Judge:  GEICO Sufficiently Alleges Fraud Claims Against Anesthesiologists

    NEWARK, N.J. — A federal judge in New Jersey on Oct. 28 denied motions to dismiss filed by three anesthesiologists accused by the Government Employees Insurance Co. (GEICO) and its subsidiaries of submitting $5.2 million in false bills for medically unnecessary procedures for patients involved in automobile accidents, holding that the company’s allegations satisfy the requirements for Federal Rule of Civil Procedure 9(b) (Government Employees Insurance Co., et al. v. Ningning He, et al., No. 19cv9465, D. N.J., 2019 U.S. Dist. LEXIS 187047).

  • October 21, 2019

    Judge Allows Amendment To Relator’s State Law Insurance Fraud Claims

    SAN FRANCISCO — A federal judge in California on Oct. 18 allowed a relator in a False Claims Act (FCA) suit brought against his former employer to amend his allegations that the company’s CEO violated the California Insurance Fraud Prevention Act (IFPA) when the company submitted claims to Medicare and other private insurers for medically unnecessary cardiovascular tests, finding that the man can include inferences that the insurers would not have paid for the tests had they known that they were not necessary (United States, ex rel. Bryan Barnette v. CardioDX Inc., et al., No. 15-cv-01339-WHO, N.D. Calif., 2019 U.S. Dist. LEXIS 181015).

  • October 17, 2019

    Evidence Demonstrated Man’s Intent To Submit False Prescriptions, Judge Says

    NEW HAVEN, Conn.  — A federal judge in Connecticut on Oct. 16 denied a man’s motion for acquittal following his conviction on two counts of health care fraud, ruling that the evidence presented during a February trial sufficiently supported the jury’s decision that the defendant intended to defraud insurance companies when submitting prescriptions to a compounding pharmacy in Mississippi using a prescription endorsed by a photocopy of a physician’s assistant’s signature (United States v. Kwasi Gyambibi, No. 18-cr-0136, D. Conn., 2019 U.S. Dist. LEXIS 179271).

  • October 17, 2019

    Social Security Disability Beneficiaries’ Request For Attorney Fees Denied By Judge

    PIKEVILLE, Ky. — Claims for attorney fees under the Equal Access to Justice Act (EAJA) brought by individuals whose requests for Social Security disability benefits were initially obtained through an attorney’s fraudulent scheme with doctors and an administrative law judge (ALJ) were denied Oct. 15 by a federal judge in Kentucky, who found that while they were prevailing parties, the SSA had substantial justification for seeking redeterminations of their benefits requests (Timothy L. Howard v. Andrew Saul, No. 16-051-DCR, E.D. Ky., 2019 U.S. Dist. LEXIS 177923).

  • October 16, 2019

    U.S. Attorney:  Doctor To Pay $1M For Fraudulently Billed Sinus Surgeries

    CEDAR RAPIDS, Iowa — The U.S. Attorney’s Office for the Northern District of Iowa announced Oct. 15 that an ear, nose and throat doctor agreed to pay $1 million to resolve allegations that she violated the False Claims Act (FCA) when submitting claims to insurers for 115 endoscopic sinus surgeries.

  • October 16, 2019

    Pennsylvania Appeals Panel: Circumstantial Evidence Supports Fraud Verdict

    HARRISBURG, Pa. — A Pennsylvania appeals panel on Sept. 30 upheld a woman’s conviction for insurance fraud and operating a vehicle without required financial responsibility, finding that the commonwealth presented sufficient evidence to show that the defendant provided a police officer with an expired insurance card, failed to inform the officer that she did not have an active policy when she was involved in an automobile accident and did not inform her insurer that she was in an accident when she did not have coverage (Commonwealth v. Renee M. Bruder, No. 1282 WDA 2018, Pa. Super., 2019 Pa. Super. Unpub. LEXIS 3687).

  • October 16, 2019

    Altered Prescription Was Properly Admitted, Pennsylvania Panel Rules

    HARRISBURG, Pa. — A woman’s convictions for insurance fraud and securing execution of documents by deception as well as her five-year sentence of probation was affirmed Oct. 15 by a Pennsylvania appeals panel that held that the commonwealth presented sufficient evidence to show that the defendant altered a prescription that allowed her to miss work and that she submitted it to her insurance company with an intent to defraud (Commonwealth v. Alvianette A. Kennedy, No. 3612 EDA 2018, Pa. Super., 2019 Pa. Super. Unpub. LEXIS 3582).

  • October 15, 2019

    Judge Finds That Allegations That Services Constitute Kickbacks Are Insufficient

    CHICAGO — A federal judge in Illinois on Sept. 30 dismissed without prejudice a registered nurse’s lawsuit contending that the Ambassador Program implemented by AbbVie Inc. and Abbott Laboratories Inc. as part of its promotion of Humira violates the False Claims Act (FCA), finding that the plaintiff’s allegations do not establish that services provided to physicians as part of the program constitute kickbacks (United States, ex rel. Lazaro Suarez v. AbbVie Inc. et al., No. 15 C 8928, N.D. Ill., 2019 U.S. Dist. LEXIS 169090).

  • October 14, 2019

    Insurer’s Fraud Claims Against Pharmacy Are Timely, Judge Rules

    TRENTON, N.J. — A federal judge in New Jersey on Sept. 30 denied a motion to dismiss an insurance company’s amended complaint accusing a pharmacy, its owner and its employees of engaging in a scheme to submit fraudulent claims for reimbursement, stating that there is insufficient evidence at the time to show that the company’s claims are barred by the state’s six-year statute of limitations (Horizon Blue Cross Blue Shield of New Jersey v. Focus Express Mail Pharmacy Inc., et al., No. 17-0571, D. N.J., 2019 U.S. Dist. LEXIS 171594).

  • October 11, 2019

    Judge Did Not Err When Imposing Sentence Above Guidelines, 11th Circuit Says

    ATLANTA — A federal judge in Florida did not err when ordering a man to a prison term that was 35 months above U.S. Sentencing Guidelines, an 11th Circuit U.S. Court of Appeals panel ruled Oct. 8, finding that the judge properly considered the defendant’s earlier conviction for health care fraud and that the subsequent scheme that led to the underlying indictment occurred just two months after his supervised release period ended (United States v. Alberto Romero Cuza, No. 19-10402, 11th Cir., 2019 U.S. App. LEXIS 30263).