Mealey's Insurance Fraud

  • December 14, 2017

    Texas Man Sentenced To 80 Years Over Fraud Scheme, False Tax Returns

    HOUSTON — A Texas man was sentenced by a federal judge to 80 years in prison for his role in a $13 million Medicare scheme and for filing false tax returns in 2013 and 2014, according to a docket entry filed Dec. 8 (United States of America v. Ebong Tilong, No. 15cr591, S.D. Texas).

  • December 14, 2017

    Evidence Of Man’s Prior Acts Of Arson Should Be Admitted, Judge Finds

    BOWLING GREEN, Ky. — Evidence related to a man’s prior acts of setting fire to three residences and one automobile to collect insurance proceeds should be admitted during his trial on similar claims, a federal judge in Kentucky ruled Dec. 13, finding that the information has probative value as to whether he committed the act as part of a common scheme or plan (United States of America v. Steven Allen Pritchard, No. 16-CR-00028, W. D. Ky., 2017 U.S. Dist. LEXIS 204958).

  • December 13, 2017

    Former Home Health Agency Owner To Serve 115 Months For $15M Fraud Scheme

    MIAMI — A federal judge in Florida on Dec. 11 sentenced the former owner and operator of a health care agency to 115 months in prison and ordered him to pay $15.1 million in restitution for his role in a conspiracy to defraud Medicare (United States of America v. Yunesky Fornaris, No 17cr20163, S.D. Fla.).

  • December 13, 2017

    11th Circuit: ‘Overwhelming Evidence’ Supported Health Care Fraud Conviction

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel on Dec. 12 upheld a man’s conviction and sentence for his role in a health care fraud scheme, finding that the government presented “overwhelming evidence” to prove that he received illegal kickbacks and conspired with his co-defendants (United States of America v. Carlos Rodriguez Nerey, No. 16-13614, 11th Cir., 2017 U.S. App. LEXIS 25026).

  • December 6, 2017

    Judge Allows Subpoena Of Insurer’s Consultants In Windstorm Coverage Dispute

    SEATTLE — Finding insufficient support for an insurer’s claim that its consultants were engaged in advance of possible insurance fraud litigation, a Washington federal judge on Dec. 5 denied the insurer’s motion to quash subpoenas served on them by the plaintiff in a coverage suit related to extreme weather events (Premier Harvest LLC, et al. v. AXIS Surplus Insurance Co., et al., No. 2:17-cv-00784, W.D. Wash., 2017 U.S. Dist. LEXIS 199910).

  • December 6, 2017

    Judge Finds No Facts To Support Claim That Insurer Wrongfully Terminated Policies

    LOS ANGELES — A California federal judge on Dec. 4 dismissed insureds’ claims for violation of California’s unfair competition law (UCL) and breach of contract, finding that they failed to show that an insurer’s termination of their life insurance policies was unreasonable (Arthur Avazian, et al. v. Genworth Life & Annuity Insurance Co., et al., No. 2:17-cv-06459, C.D. Calif., 2017 U.S. Dist. LEXIS 199067).

  • December 5, 2017

    Home Health Agency Owner Convicted For Role In $1.6M Medicare Fraud Scheme

    DETROIT — The owner of a home health agency that allegedly submitted $1.6 million in fraudulent claims to Medicare for services that were either medically unnecessary or not performed was found guilty by a federal jury in Michigan on Dec. 4 (United States of America v. Editha Manzano, et al., No. 16cr20593, E.D. Mich.).

  • December 4, 2017

    GEICO’s Insurance Fraud, RICO Claims Not Subject To Arbitration, Judge Says

    CAMDEN, N.J. — A federal judge in New Jersey on Dec. 1 refused to dismiss a lawsuit brought by the Government Employees Insurance Co. (GEICO) over an alleged fraudulent billing scheme by doctors at two orthopedic firms, finding that the insurer’s claims under the Racketeer Influenced and Corrupt Organizations Act and the New Jersey Insurance Fraud Prevention Act (IFPA) are not subject to arbitration (Government Employees Insurance Company v. Regional Orthopedic Professional Association, et al., No. 17-1615, D. N.J., 2017 U.S. Dist. LEXIS 197599).

  • December 1, 2017

    Divided Appeals Court Affirms Dismissal Of Fraud Claim Against Drapery Company

    PHILADELPHIA — A 2-1 panel of the Pennsylvania Superior Court on Nov. 20 affirmed the dismissal of a grand jury’s indictment of a drapery sales company accused of being involved in an insurance fraud scheme, finding that the evidence presented by the state did not establish a prima facie case against the company (Commonwealth v. Richard Holston, No. 223 EDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4276).

  • December 1, 2017

    5th Circuit Vacates $4M Restitution, Forfeiture Order Against Physician Assistant

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 30 overturned a federal judge in Texas’ ruling ordering a physician’s assistant found guilty of conspiracy to commit insurance fraud to pay $4 million in restitution and forfeiture, holding that the man should be required to reimburse the government only for the proceeds he obtained from the scheme (United States of America v. Mansour Sanjar, et al., No. 15-20025, 5th Cir., 2017 U.S. App. LEXIS 24252).

  • November 22, 2017

    $1.5M Settlement Reached In False Claims Dispute Over Substandard Nursing Home Care

    JACKSON, Miss. — The operators of a Mississippi nursing home have agreed to pay the United States a total of $1.25 million to resolve allegations that they provided false claims to Medicare and the Mississippi Medicaid program related to the provision of “grossly substandard care” to residents, the U.S. Department of Justice announced Nov. 16.  The same day, a Mississippi federal judge dismissed a relator’s second amended complaint and the United States’ complaint in intervention in the qui tam action after the parties stipulated to dismissal (United States, ex rel., Academy Health Center Inc. v. Hyperion Foundation Inc., et al., No. 10-00552, S.D. Miss.).

  • November 15, 2017

    Doctor Sentenced To 5 Years In Prison For Fraud, Money-Laundering Scheme

    MIAMI — A federal judge in Florida on Nov. 8 sentenced a doctor to five years in prison and ordered him to pay $2.1 million in restitution for his role in an health care fraud and money-laundering scheme that involved the filing of fraudulent insurance claim forms and defrauding health care benefit programs (United States of America v. Kenneth Chatman, et al., No. 17cr80013, S.D. Fla.).

  • November 15, 2017

    Woman Convicted For Role In $3.2M Kickback Scheme To Provide Medical Equipment

    NEW ORLEANS  — A federal judge in Louisiana on Nov. 8 found a woman guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks, two counts of health care fraud and five counts of accepting kickbacks for her role in a $3.2 million scheme that involved providing durable medical equipment to Medicare beneficiaries that was medically unnecessary (United States of America v. Tracy Richardson Brown, et al., No. 13-cr-243, E.D. La.).

  • November 15, 2017

    State Farm Can Pursue Trade Practices Claims Over Billing Scheme, Judge Says

    MIAMI — State Farm Mutual Automobile Insurance Co. can pursue claims under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) against medical facilities accused of participating in a fraudulent billing scheme that caused the insurer to incur damages exceeding $3.8 million, a federal judge in Florida ruled Sept. 25, ruling that State Farm sufficiently stated claims for relief under the act (State Farm Mutual Automobile Insurance Company v. Performance Orthopaedics & Neurosurgery, LLC, et al., No. 17-cv-20028-KMM, S.D. Fla., 2017 U.S. Dist. LEXIS 156284).

  • November 14, 2017

    Intervenor’s Request To Amend Pleadings Against Insurer Untimely, Judge Says

    GREENBELT, Md. — An intervening party in an insurance company’s lawsuit accusing an insured of making material misrepresentations on a policy application cannot amend its pleadings to change admissions and add counterclaims, a federal judge in Maryland ruled Nov. 13, finding that the request was untimely (CX Insurance Company v. Benjamin L. Kirson, No. 15-cv-3132, D. Md., 2017 U.S. Dist. LEXIS 187164).

  • November 10, 2017

    Doctor Sentenced To 15 Years, Ordered To Pay $9.1 M For Fraud Scheme

    DETROIT — A doctor was sentenced to 15 years in prison and ordered to pay $9.1 million in restitution by a federal judge in Michigan on Nov. 8 after being found guilty for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided (United States of America v. John Trotter II, et al., No. 14cr20273, E.D. Mich.).

  • November 10, 2017

    Fabricated Authorization Letter Constituted Fraud, Pennsylvania Appeals Court Finds

    PITTSBURGH — A woman was properly convicted for insurance fraud, forgery and theft of property, a Pennsylvania appeals panel ruled Nov. 7, finding that the woman’s presentation of a fabricated authorization letter for dental work constituted an attempt to defraud her insurance company (Commonwealth of Pennsylvania v. Amy Lee Palmer, No. 1039 WDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4117).

  • November 10, 2017

    Pennsylvania Panel Upholds Woman’s Conviction, Sentence For Insurance Fraud

    PHILADELPHIA — A Pennsylvania appeals panel on Nov. 7 overruled a woman’s argument that evidence presented during her insurance fraud trial did not support her conviction, holding that the state sufficiently showed an intent to defraud through her false statements to a state trooper during the investigation of a car fire (Commonwealth of Pennsylvania v. Ruth E. Gettel, No. 533 MDA 2017, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4101).

  • November 9, 2017

    Evidence Supported Convictions For Fraud, Kickback Charges, 5th Circuit Says

    NEW ORLEANS — A Fifth Circuit U.S. Court of Appeals panel on Nov. 7 upheld convictions of a man and his son who were accused of health care fraud and paying kickbacks to obtain business for their partial hospitalization programs (PHPs), ruling that evidence presented by the government was sufficient to support the jury’s verdict (United States of America v. Earnest Gibson III, et al., No. 15-20323, 5th Cir., 2017 U.S. Dist. LEXIS 22261).

  • November 7, 2017

    Judge: Antagonistic Defenses Do Not Warrant Severing Insurance Fraud Defendants

    NEW YORK — A federal judge in New York on Nov. 3 denied motions filed by two doctors seeking to sever their claims from a criminal insurance fraud indictment, finding that the defendants’ antagonistic defenses and the possibility of prejudicial spillover did not warrant severance (United States of America v. Asim Hameedi, et al., No. 17 Cr. 137, S.D. N.Y., 2017 U.S. Dist. LEXIS 182790).