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Mealey's Insurance Fraud

  • July 19, 2018

    6th Circuit Allows Amicus Briefs Seeking Rehearing Of Medicare Billing Case

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on July 16 granted requests from the Washington Legal Foundation (WLF) and National Association for Home Care & Hospice Inc. (NAHCH) to submit amicus curiae briefs in support of a nursing home facility’s request for an en banc hearing as to whether a former worker sufficiently alleged that the company made material misrepresentations under the False Claims Act (FCA) when failing to timely submit physician certification to support treatment provided to patients (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir.).

  • July 19, 2018

    Ambulance Company To Pay $16,776 For Submitting False Claims

    BANGOR, Maine — An ambulance company has agreed to pay the federal government and state of Maine $16,776.74 to resolve claims that it submitted false bills to Medicare and Maine’s Medicaid program, MaineCare, from January 2015 through April 2016 to pay the salary of an employee who had previously been excluded from participating in federal and state health care programs, according to a notice of settlement filed July 17 in Maine federal court (United States v. County Ambulance Service Inc., No. 18-cv-280, D. Maine).

  • July 18, 2018

    Ohio Panel Vacates Nationwide’s Summary Judgment Ruling Over Misrepresentation

    YOUNGSTOWN, Ohio — An Ohio appeals panel on June 29 overturned a ruling awarding summary judgment to Nationwide Mutual Fire Insurance Co., finding that the company’s policy application did not specifically state that a misrepresentation would void the policy (Nationwide Mutual Fire Insurance Co. v. Barbara Pusser, et al., No. 17 MA 0117, Ohio App., 7th Dist., 2018 Ohio App. LEXIS 2988).

  • July 18, 2018

    Nevada Appeals Court Majority Says Man Should Be Resentenced For Fraud

    LAS VEGAS — A man who was convicted on two felony counts of insurance fraud should be resentenced, a 2-1 Nevada Court of Appeals ruled June 22, finding that the state failed to present sufficient evidence showing that the value of items the defendant attempted to obtain proceeds from exceeded $650 (Tarek Diab Gohar v. Nevada, No. 73872, Nev. App., 2018 Nev. App. Unpub. LEXIS 511).

  • July 17, 2018

    California Panel Affirms Restitution Amount For Unemployment Benefits Fraud

    SAN FRANCISCO — A California appeals court panel on July 16 affirmed a trial court’s ruling requiring a flower shop owner to pay $14,200 in restitution to a former employee after she pleaded no contest to fraud charges stemming from her failure to pay for unemployment and workers’ compensation insurance, finding that while the former employee’s work records “were a mess,” the trial judge properly calculated the amount needed to make the victim whole (People of California v. Cynthia Ann Smith, No. A153490, Calif. App., 1st Dist., 5th Div., 2018 Cal. App. Unpub. LEXIS 4769).

  • July 17, 2018

    Bank For Clinic Accused Of Fraud Must Produce Records, Magistrate Says

    TAMPA, Fla. — A health care clinic and doctor accused of submitting fraudulent medical bills for automobile accident victims to the Government Employees Insurance Co. (GEICO) failed to have a subpoena served on their bank quashed after a federal magistrate judge in Florida ruled July 16 that the records were relevant and not protected from disclosure (Government Employees Insurance Company v. Analgesic Healthcare Inc., et al., No. 17-cv-1130-T-27AAS, M.D. Fla., 2018 U.S. Dist. LEXIS 117887).

  • July 12, 2018

    Magistrate: ‘Serial Fraudster’ Should Remain Detained Due To Flight Risk

    WEST PALM BEACH, Fla.  — The owner of a sober house accused of health care fraud for running a scheme involving the submission of bills to insurers for medically unnecessary drug screening tests should remain detained pursuant to the Bail Reform Act of 1984 because he is a “serial fraudster and an economic danger to the community,” a federal magistrate judge in Florida ruled July 6 (United States v. Kenneth Bailynson, et al., No. 18-cr-80124, S.D. Fla., 2018 U.S. Dist. LEXIS 113820).

  • July 12, 2018

    Doctor’s Indictment Adequately Alleges Claim For Health Care Fraud, Judge Rules

    LONDON, Ky. — A federal judge in Kentucky on July 3 denied a doctor’s motion to dismiss a charge of health care fraud from his indictment, finding that the allegations are sufficient to put the doctor on notice of the claims against which he must defend (United States v. Ezekiel Akande, M.D., No. 17-cr-0013-GFVT-HAI, E.D. Ky., 2018 U.S. Dist. LEXIS 111593).

  • July 10, 2018

    1st Circuit: Juror’s Use Of Dictionary Does Not Warrant New Fraud Trial

    BOSTON— A First Circuit U.S. Court of Appeals panel ruled July 9 that while a federal judge in Puerto Rico abused his discretion when granting a juror’s oral request for a dictionary to look up the word “knowingly” during deliberations of a mail fraud trial against a doctor, the error was not prejudicial enough to warrant a new trial for the defendant (United States v. Anibal Pagan-Romano, No. 16-1396, 1st Cir., 2018 U.S. App. LEXIS 18594).

  • July 10, 2018

    Judge: Contract Claims In Suit Over Crop Insurance Fraud Subject To Arbitration

    MINNEAPOLIS— A federal judge in Minnesota on July 6 dismissed two breach of contract claims from a man’s False Claims Act (FCA) lawsuit accusing six farm owners of illegally obtaining crop insurance proceeds, finding that the causes of action are subject to arbitration pursuant to a partnership agreement between the parties (United States, ex rel. Kenneth Kraemer, et al. v. United Dairies LLP, et al., No. 16-3092, D. Minn., 2018 U.S. Dist. LEXIS 112305).

  • July 10, 2018

    Doctor’s 68-Month Prison Sentence For Fraud Upheld By 6th Circuit

    CINCINNATI — A federal judge in Michigan did not abuse his discretion when resentencing a doctor convicted of health care fraud conspiracy, conspiracy to pay health care kickbacks and conspiracy to distribute a controlled substance to 68 months in prison, a Sixth Circuit U.S. Court of Appeals panel ruled June 25, holding that the judge sufficiently explained the starting point for the sentence and asked the defendant and his counsel if they read the presentence report (United States v. Carl Fowler, M.D., No. 17-1100, 6th Cir., 2018 U.S. App. LEXIS 17370).

  • July 2, 2018

    Magistrate Judge Agrees To Strike Some Portions of Fire Loss Indictment

    SOUTH BEND, Ind. — A federal magistrate judge in Indiana on June 29 agreed to strike two paragraphs from a man’s indictment on four counts of mail fraud stemming from an alleged scheme to intentionally set fires to homes he owned to collect insurance proceeds, finding that the information in the paragraphs was unnecessary (United States of America v. Michael Thomas, No. 18-CR-00045 JD, N.D. Ind., 2018 U.S. Dist. LEXIS 108983).

  • June 29, 2018

    11th Circuit Upholds Man’s 27-Month Sentence For False Health Care Statements

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on June 27 ruled that a federal judge in Georgia did not err when sentencing a Veterans Administration (VA) clinic’s former chief of the fee division to 27 months in prison for 50 counts of making false statements in connection with the delivery of, or payment for, health care services and one count of making a materially false statement to a federal agent, finding that the evidence presented by the government was sufficient and that the trial court judge did not err when imposing the sentence (United States of America v. Cathedral Henderson, No. 16-16984, 11th Cir., 2018 U.S. App. LEXIS 17634).

  • June 29, 2018

    Misrepresentations On Loss Of Personal Belongings After Fire Were Material

    MINNEAPOLIS — A federal judge in Minnesota on June 26 denied a family’s motion for judgment as a matter of law, finding that State Farm Fire and Casualty Co. sufficiently showed during trial that the insureds made material misrepresentations about items that were lost in a fire (Todd Borchardt, et al. v. State Farm Fire and Casualty Co., No. 16-CV-0055, D. Minn., 2018 U.S. Dist. LEXIS 107355).

  • June 27, 2018

    Criminal Investigation Of Doctors, Clinic, Does Not Warrant Staying Depositions

    NEW YORK — A criminal investigation by the New York Attorney General’s Office to the billing practices of doctors and two clinics accused by State Farm Mutual Automobile Insurance Co. of submitting fraudulent claims and medical records does not warrant staying the defendants’ depositions, a federal magistrate judge in New York ruled June 25, noting that there hasn’t been any activity in the investigation for nearly a year (State Farm Mutual Automobile Insurance Co. v. Brij Mittal, M.D., et al., No. 16-CV-4948, E.D. N.Y., 2018 U.S. Dist. LEXIS 106100).

  • June 26, 2018

    Doctors Accused Of Inflating Bills Can Face Insurer’s Lawsuit, Judge Says

    LAS VEGAS — A number of doctors accused of fraudulently inflating bills that were submitted to Allstate Insurance Co. and its subsidiaries so patients could attempt to extract more money from the company in personal injury lawsuits can face a lawsuit filed by the insurer, a federal judge in Nevada ruled June 18, finding that the claims are not barred by the Nevada litigation privilege or federal witness immunity (Allstate Insurance Co., et al. v. Russell J. Shah, M.D., et al., No. 15-cv-01786, D. Nev., 2018 U.S. Dist. LEXIS 101952).

  • June 25, 2018

    Kentucky Appeals Court Upholds Revocation Of Fraud Defendant’s Probation

    FRANKFORT, Ky. — A Kentucky appeals court panel on June 22 upheld a trial judge’s ruling revoking probation for a man who pleaded guilty to insurance fraud, holding that the defendant’s probation violations resulted in a threat to the community (Richard N. Thompson v. Kentucky, Nos. 2015-CA-001938, Ky. App., 2018 Ky. App. Unpub. LEXIS 434).

  • June 21, 2018

    Judge Finds Service On Niece Of Doctor Accused Of Fraud Sufficient

    ANN ARBOR, Mich. — A federal judge in Michigan on June 19 denied a doctor’s motion to dismiss a lawsuit brought by Allstate Insurance Co. accusing him and his practice of submitting fraudulent claims, finding that service of the complaint to his niece was sufficient to establish that he lived there (Allstate Insurance Co., et al. v. Utica Physical Therapy Inc., et al., No. 17-cv-13823, E.D. Mich., 2018 U.S. Dist. LEXIS 101764).

  • June 20, 2018

    Judge Adopts Recommendation To Revoke Fraud Defendant’s Supervised Release

    COVINGTON, Ky. — A federal judge in Kentucky on June 19 adopted a magistrate judge’s June 15 recommendation to order a man who pleaded guilty to three counts of aiding and abetting insurance fraud to serve 14 months in prison for violating the conditions of his supervised release (United States of America v. Roben Casey Bykovny, No. 15-36-DLB-CJS-7, E.D. Ky.).

  • June 18, 2018

    11th Circuit: Evidence Supported Convictions For Arson Scheme

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on June 14 affirmed rulings by a federal judge in Georgia denying two defendants’ motions for acquittal, holding that the evidence presented by the government sufficiently showed that they conspired and committed mail fraud as part of a scheme to submit fraudulent insurance claims after setting homes on fire (United States v. Shirley Denise Burk, et al., No. 16-14248, 11th Cir., 2018 U.S. App. LEXIS  15979).