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Mealey's Insurance Fraud

  • September 19, 2018

    Judge Trims Former Laboratory Director’s Suit Over Kickbacks, False Billing

    WASHINGTON, D.C. — A federal judge in the District of Columbia on Sept. 12 dismissed in part claims brought by a former laboratory director accusing a company of violating the False Claims Act (FCA) and Anti-Kickback Statute (AKS) when submitting claims to Medicare for lipid screening tests, finding that he did not sufficiently allege that the company could be liable for self-referrals, charging speaker fees for a doctor and nurse practitioner and submitting claims for medically unnecessary tests (United States, ex rel. Chris Riedel v. Boston Heart Diagnostics Corp., No. 12-1423, D. D.C., 2018 U.S. Dist. LEXIS 155113).

  • September 20, 2018

    Judge Sentences Podiatrist To 28 Months In Prison For Health Care Fraud

    ANN ARBOR, Mich. — A podiatrist was sentenced to 28 months in prison by a federal judge in Michigan on Sept. 11 for conducting a $1 million health care fraud scheme that involved submitting bills to Medicare for services that were never provided (United States of America v. Lawrence Young, No. 17cr20240, E.D. Mich.).

  • September 20, 2018

    Ohio Pharmacist Sentenced For Billing Insurers For Prescription Drug Samples

    COLUMBUS, Ohio — A federal judge in Ohio on Sept. 11 sentenced a pharmacist to two years in prison and ordered her to pay $1.1 million in restitution after she pleaded guilty to one count of health care fraud for submitting false claims to Medicare, Ohio Medicaid and the Ohio Bureau of Workers’ Compensation for free samples of prescription drugs she received from manufacturers (United States of America v. Maria Mascio, No. 14cr272, S.D. Ohio).

  • September 19, 2018

    Magistrate Judge Finds Relator’s Request For Metadata From State Farm Premature

    GULFPORT, Miss. — Requests for metadata from State Farm Fire and Casualty Co.’s claims database and for spoliation sanctions sought by a plaintiff in a False Claims Act suit accusing the insurer of submitting false claims for flood damage following Hurricane Katrina were deemed premature by a federal magistrate judge in Mississippi on Sept. 18, after he found that the plaintiff’s request for additional information from the insurer should stem from the claims files it has produced (United States of America, ex rel. Cori Rigsby, et al. v. State Farm Fire and Casualty Co., No. 06cv433-HSO-RHW, S.D. Miss., 2018 U.S. Dist. LEXIS 158641).

  • September 18, 2018

    Farmer Accused Of Filing False Reports With Federal Reinsured Crop Policies

    LEXINGTON, Ky. — The U.S. government filed an indictment on Sept. 6 in a Kentucky federal court against a farmer for submitting false reports regarding federally reinsured crop insurance policies (United States of America v. Christopher G. Hickerson, No. 18-cr-00111, E.D. Ky.).

  • September 11, 2018

    5th Circuit: Judge Did Not Err When Dismissing Relator’s False Billing Claims

    NEW ORLEANS — A federal judge in Texas did not abuse her discretion when granting a motion for voluntary dismissal with prejudice filed by relators in a False Claims Act (FCA) suit accusing the owner of a number of allergy centers of submitting false bills to Medicare and dismissing the government without prejudice, finding that the government and the judge properly consented to the dismissal (United States, ex rel. Michael Vaughn, et al. v. United Biologics LLC, No. 17-20389, 5th Cir., 2018 U.S. App. LEXIS 25450).

  • September 10, 2018

    Connecticut Appeals Panel Vacates Woman’s Conviction For Insurance Fraud

    HARTFORD, Conn. — A Connecticut appeals court panel on Sept. 10 vacated a woman’s conviction for insurance fraud, holding that the same evidence used to support her conviction for two counts of arson could not be used to support the jury’s decision to find her guilty of insurance fraud (Connecticut v. Madeline Griffin, No. AC 40555, Conn. App., 2018 Conn. App. LEXIS 351).

  • September 6, 2018

    Judge Denies Government’s, Executive’s Summary Judgment Motions Over Kickbacks

    CHICAGO — A federal judge in Illinois on Sept. 4 denied motions for summary judgment filed by the federal government and a hospital executive who was found guilty of violating the False Claims Act’s (FCA) Anti-Kickback Statute (AKS), ruling that the defendant did not admit liability as part of his conviction and that the government can seek damages based on payments the defendant received from Medicare and Medicaid (United States v. Edward J. Novak, No. 17 C 4887, N.D. Ill., 2018 U.S. Dist. LEXIS 150234).

  • September 5, 2018

    Montana High Court Vacates Ruling Ordering Fraud Defendant To Pay Fines

    HELENA, Mont. — A panel of the Montana Supreme Court on Sept. 4 reversed a trial court judge’s ruling requiring a woman convicted on two counts of attempted theft by insurance fraud to pay $7,430 in fines, costs and fees, holding that the judge failed to properly consider her ability to pay (Montana v. Dawn Marie Hamilton, No. DA 17-0271, Mont. Sup., 2018 Mont. LEXIS 292).

  • September 4, 2018

    6th Circuit Denies Request For En Banc Hearing In Medicare Billing Case

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Aug. 22 denied a senior living center’s request for an en banc rehearing of a ruling reversing dismissal of a former employee’s False Claims Act suit, finding that “the issues raised in the petition were fully considered upon the original submission and decision” (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir.).

  • August 29, 2018

    Insurer’s Summary Judgment Motion In Fire Loss Suit Denied By Judge

    CHICAGO — A jury should determine if alleged misrepresentations made by a man whose home was destroyed by a fire intended to deceive his insurance company, a federal judge in Illinois ruled Aug. 27 in denying the insurer’s motion for summary judgment (State Auto Property & Casualty Insurance Co. Inc. v. Anthony Blair Jr., No. 15 C 8026, N.D. Ill., 2018 U.S. Dist. LEXIS 145335).

  • August 28, 2018

    6th Circuit Affirms Man’s Convictions For Claims Stemming From Fraud Scheme

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Aug. 23 upheld a man’s convictions for health care fraud, naturalization fraud and mail fraud, finding that a federal judge in Michigan did not err when admitting certain testimony from an individual involved in the fraudulent billing scheme and that the evidence presented during the trial was sufficient to support the jury’s decision (United States of America v. Antonio Ramon Martinez-Lopez, No. 17-1860, 6th Cir., 2018 U.S. App. LEXIS 23799).

  • August 27, 2018

    High Court Refuses To Reconsider Denial Of Review Of Accidental Death Claim Suit

    WASHINGTON, D.C. — The U.S. Supreme Court on Aug. 24 stood by its decision to not review the Fifth Circuit U.S. Court of Appeals’ ruling in favor of an insurer in the appellant’s breach of contract lawsuit seeking $750,000 as a beneficiary under an accidental death policy (Abdul Salam Badmus v. Mutual of Omaha Insurance Company [MOOIC], No. 17-7884, U.S. Sup.).

  • August 23, 2018

    DOJ: Physician Who Participated In $30M Fraud Scheme Sentenced

    NEW YORK— A physician who falsely claimed that he was the owner of two clinics that submitted bills to Medicare for services that were either not provided or medically necessary was sentenced Aug. 21 by a federal judge in New York to 366 days in prison and ordered to pay $1.8 million in restitution, the U.S. Department of Justice announced Aug. 22 (United States v. Mustak Y. Vaid, et al., No. 16cr763, S.D. N.Y.).

  • August 20, 2018

    Pennsylvania Appeals Court Tosses Office Manager’s Insurance Fraud Conviction

    HARRISBURG, Pa. — A Pennsylvania Superior Court panel on Aug. 16 vacated a woman’s conviction for insurance fraud, finding that Medicare does not qualify as an insurer for the purposes of the statute she was accused of violating (Pennsylvania v. Rameeza S. Chowdhury, No. 577 MDA 2017, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 2962).

  • August 16, 2018

    Pharmacy Owner Pleads Guilty For Submitting False Bills For Prescriptions

    EAST ST. LOUIS, Ill. — A pharmacist and pharmacy owner on Aug. 14 pleaded guilty in Illinois federal court to two counts of health care fraud for submitting false claims for prescriptions that were not authorized by a physician (United States v. Steven P. Gibson, No. 18-cr-30127, S.D. Ill.).

  • August 15, 2018

    Judge Did Not Err When Sentencing Man For Identity Theft, 6th Circuit Says

    CINCINNATI — A federal judge in Michigan did not err when sentencing a man to 72 months in prison after he pleaded guilty to aggravated identity theft as part of a scheme to fraudulently obtain unemployment insurance benefits, a Sixth Circuit U.S. Court of Appeals panel ruled Aug. 13, finding that the judge did not err when denying the defendant’s motion to withdraw the plea and properly calculated the man’s sentence (United States of America v. Edward C. Galka, No. 17-2216, 6th Cir., 2018 U.S. App. LEXIS 22491).

  • August 14, 2018

    Judge Dismisses Majority Of Doctor’s Counterclaims Against Insurer Over Coverage

    CONCORD, N.H. — A federal judge in New Hampshire on Aug. 13 dismissed six of an ophthalmologist’s eight counterclaims against an insurance company seeking to rescind a policy issued to him and his practice, finding that he could not pursue claims under Massachusetts law because New Hampshire law applies to the suit and because the insurer’s complaint cannot form the basis for counterclaims of libel, defamation and false light (General Star Indemnity Co. v. Adam P. Beck M.D., et al., No. 18-cv-108-JD, D. N.H., 2018 U.S. Dist. LEXIS 136019).

  • August 14, 2018

    North Carolina Appeals Panel Vacates Man’s Conviction For Insurance Fraud

    RALEIGH, N.C. — A North Carolina appeals panel on Aug. 7 vacated a man’s conviction for insurance fraud after finding that the state failed to present sufficient evidence to show that he made a fraudulent statement to his insurance company about the cause of a fire that destroyed a diner he helped operate (North Carolina v. Eric Ferrer, No. COA17-655, N.C. App., 2018 N.C. App. LEXIS 760).

  • August 13, 2018

    Woman Withdraws Not Guilty Plea To Health Care Fraud

    BENTON, Ill. — An Illinois woman on Aug. 10 pleaded guilty to one felony count of health care fraud in Illinois federal court after withdrawing her earlier plea of not guilty (United States of America v. Betsy Gutowski, No. 17cr40046, S.D. Ill.).