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Mealey's Insurance Fraud

  • March 26, 2025

    Report Adopted, Dismissal Denied In $300M Class Ponzi Suit Against Wells Fargo

    MIAMI — Agreeing with a magistrate judge’s “well-reasoned findings,” a Florida federal judge adopted the magistrate judge’s report and recommendation and denied Wells Fargo’s dismissal motion in a putative class action alleging that Wells Fargo aided and abetted fraud in a “massive” Ponzi scheme purportedly orchestrated by owners of insurers, some of which are now in receivership, resulting in elderly investor victims losing more than $300 million after scheme operators sold them promissory notes secured by collateral in stranger-oriented life insurance policies (STOLIs).

  • March 25, 2025

    Judgment Granted For Insurer In Row Over $1M Life Policy Rescission For DUI Denial

    DETROIT — A Michigan federal judge on March 24 granted an insurer’s summary judgment motion and its declaratory judgment counterclaim in a breach of contract suit against it by the beneficiary of a $1 million life insurance policy, finding that the insurer was entitled to rescind the policy because it relied on material misrepresentations in the decedent’s application for reinstatement of her policy when she falsely denied having DUI/DWI convictions or a license revocation in the last 10 years.

  • March 24, 2025

    Unjust Enrichment Claim Tossed In State Farm Suit Over Fraud Referral ‘Scheme’

    TAMPA, Fla. — A Florida federal judge on March 21 granted in part dismissal motions filed by a Florida medical provider and related entities and physicians in State Farm’s suit asserting that they violated the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) and were unjustly enriched by participating in a “scheme” of unlawful patient referral to surgery centers and submitting charges of more than $3.3 million for inclusion in settlement demands to State Farm.

  • March 20, 2025

    Split Louisiana Panel Affirms Order To Pay $50,000 To Life Policy Beneficiary

    GRETNA, La. — A split Louisiana appellate court panel on March 19 affirmed in part a lower court order requiring a life insurer to pay a policy beneficiary $50,000, the face value of a life insurance policy, finding that the lower court did not err in its determination that the insurer failed to show that the decedent “made material misrepresentations with an intent to deceive” in the policy application.

  • March 19, 2025

    Panel Affirms Order Granting Disposition In Favor Of Insurer In PIP Coverage Row

    DETROIT — A Michigan appellate court on March 18 affirmed a lower court ruling granting summary disposition in favor an insurer in a suit by a woman injured in a car accident seeking personal injury protection (PIP) benefits, finding that the lower court did not err in its determination that the woman “knowingly made false statements material to her claim for PIP benefits.”

  • March 18, 2025

    Relators Granted Judgment In FCA Suit Against Woman Convicted Of Criminal Fraud

    BIRMINGHAM, Ala.  — An Alabama federal judge on March 17 granted summary judgment to qui tam relators who sued a psychologist and her practice where they once worked, alleging violations of the False Claims Act (FCA) regarding billing Medicaid for upcoded services, finding that because of a judgment against the psychologist in a related criminal case, she “is estopped” from denying that she engaged in “fraudulent conduct in this action.”

  • March 18, 2025

    Insurance Mogul Ordered To ‘Pay Disgorgement’ In SEC Fraud Suit Against Him

    WINSTON-SALEM, N.C. — A North Carolina federal judge entered judgment against insurance mogul Greg Lindberg, a former owner of insurers in liquidation and rehabilitation, requiring him to “pay disgorgement of ill-gotten gains and prejudgment” in response to the U.S. Securities and Exchange Commission’s motion for judgment, with Lindberg’s consent, in its suit alleging that he, his advisory services company and its former executive defrauded clients of more than $75 million.

  • March 18, 2025

    Life Insurer Sues Insured Over $1M Policy, Seeks Policy Voidance For Fraud

    SANTA ANA, Calif. — A life insurer sued its purported insured in a California federal court seeking to rescind and void a $1 million policy because the application for insurance was allegedly submitted by someone other than the proposed insured, who “fraudulently” masqueraded “as the purported applicant and proposed insured,” asserting that had it known that someone other than the insured submitted the application, it would not have issued the policy.

  • March 17, 2025

    Dismissal Bids Fought In Row Over Vesttoo-Linked Letters Of Credit

    NEW YORK — In four motions that have drawn opposition, China Construction Bank Corp. (CCBC) and related defendants seek dismissal of claims that stem from the alleged fraud underlying the collapse of nonparty Vesttoo Ltd., arguing primarily that the New York federal court lacks jurisdiction and the claims are not sufficiently stated.

  • March 12, 2025

    Judge Withdraws Earlier Ruling In Policy Row Over Criminal History Information

    HOUSTON — A Texas federal judge on March 12 withdrew a ruling issued nine days earlier that denied summary judgment to a life insurance policy beneficiary in her suit against the insurer for its failure to pay benefits under the policy, finding that failure to withdraw the earlier ruling was in error because after the insurer filed its amended answer, the judge issued a March 6 ruling that also denied summary judgment to the insured.

  • March 12, 2025

    Allstate Files RICO, Fraud Suit Against Florida Surgery Center And Affiliates

    ORLANDO, Fla. — Allstate filed a suit in a Florida federal court against a Florida surgery center and its affiliates for alleged fraud and federal and state Racketeer Influenced and Corrupt Organizations (RICO) Act violations related to a purported “scheme” committed by the defendants by billing Allstate for medical services that were not performed or were not medically necessary.

  • March 12, 2025

    Special Master Advises Granting Judgment For Insurer In Reverse FCA Medicare Row

    LOS ANGELES  — A special master filed a report and recommendation in a California federal court advising that the court should grant summary judgment to UnitedHealth Group Inc. and its subsidiaries (United) and deny partial summary judgment to the government in its suit accusing United of reverse false claims violations of the federal False Claims Act (FCA) by allegedly “improperly” keeping money paid to it by the government for United’s Medicare Advantage members, finding that the government failed to provide evidence to support its reverse FCA claims.

  • March 11, 2025

    Medical Providers, Insurers Urge 11th Circuit To Affirm Dismissal Of FCA Suit

    ATLANTA — Medical providers and Medicare Advantage (MA) insurers filed an appellee brief on March 10 in the 11th Circuit U.S. Court of Appeals urging the court to uphold a district court’s ruling that dismissed for lack of standing under Article II of the U.S. Constitution a qui tam relator’s suit alleging that the medical providers and MA insurers violated the False Claims Act (FCA).

  • March 07, 2025

    Insurance Mogul Files Response To Summary Judgment In SEC Fraud Suit Against Him

    WINSTON-SALEM, N.C. — Insurance mogul Greg Lindberg, a former owner of insurers in liquidation and rehabilitation, filed in a North Carolina federal court a response to the U.S. Securities and Exchange Commission’s motion for summary judgment in its suit alleging that he, his advisory services company and its former executive defrauded clients of more than $75 million.

  • March 07, 2025

    Jury Issues No Damages Verdict In FCA Suit On Remand From U.S. Supreme Court

    SPRINGFIELD, Ill. — An Illinois federal court jury issued a verdict awarding no damages in a case on remand from the U.S. Supreme Court in which the high court ruled that that pharmacies accused of fraudulently overcharging Medicare, Medicaid and the Federal Employee Health Benefits Program for prescription drugs in violation of the False Claims Act (FCA) “could have the scienter required by the FCA if they correctly understood” the standard of “usual and customary” drug prices when billing Medicare and Medicaid and thought that “their claims were inaccurate.”

  • March 07, 2025

    DOJ Announces $450K Settlement In Medicare Fraud Suit Involving Acupuncture Device

    LAKE CHARLES, La. — Acting U.S. Attorney Alexander C. Van Hook of the U.S. District Court for the Western District of Louisiana on March 6 announced that a physician and his wife who cofounded a medical clinic agreed to pay $450,000 to resolve allegations that they violated the False Claims Act (FCA) by improperly billing Medicare for noncovered electric acupuncture devices.

  • March 07, 2025

    Judgment Granted To Insurer In Suit Over Rescission, Underlying Suit Defense

    NEWARK, N.J. — A New Jersey federal judge granted an insurer’s motion for default judgment in its suit seeking a declaratory judgment that it is entitled to rescind policies issued to its insured contractor and owes no duty to defend or indemnify the contractor in underlying state court litigation, finding “no circumstances that would render the entry of default judgment improper.”

  • March 06, 2025

    Judge Grants Judgment For Insurers In Condominium Attorney Fee Dispute

    NEW YORK — A New York federal judge granted summary judgment for insurers as to a condominium association’s claim for attorney fees in a breach of contract suit filed against insurers over their failure to cover a condominium’s hurricane-related losses, finding that because New York law applies and lacks a provision justifying attorney fee recovery, the claim for attorney fees under Florida law fails.

  • March 05, 2025

    11th Circuit Transfers GEICO Attorney Fee Motion To District Court In Fraud Suit

    ATLANTA — The 11th Circuit U.S. Court of Appeals granted a motion filed by GEICO to transfer its motion for appellate attorney fees to a district court that entered a $690,251.44 judgment for the insurer in its suit against a health care clinic and related parties for allegedly submitting fraudulent no-fault insurance charges.

  • March 05, 2025

    Judgment Denied To Life Policy Beneficiary Over No Incarceration Disclosure

    HOUSTON — A Texas federal judge denied a life insurance policy beneficiary’s motion for summary judgment in her breach of contract suit against an insurer for its failure to pay benefits under the policy, finding that the insurer is entitled to cancel the policy due to the beneficiary’s failure to accurately represent the insured’s criminal history in the policy application.

  • March 03, 2025

    Mich. High Court Won’t Review Ruling Affirming Summary Disposition For Allstate

    LANSING, Mich. — Finding that it was “not persuaded that the questions presented should be reviewed by this Court,” the Michigan Supreme Court denied an auto insurer’s application for leave to appeal a Michigan appellate court’s ruling affirming a lower court’s grant of summary disposition in favor of Allstate Insurance Co. in its suit against the auto insurer, seeking reimbursement for $521,872.82 in personal injury protection (PIP) benefits Allstate paid on behalf of a man fatally injured in a moped accident.

  • March 03, 2025

    Judgment Granted For Insurer In Row Over Sinking Vessel Coverage, Policy Voidance

    MIAMI — A Florida federal judge adopted a magistrate judge’s report and recommendation to grant summary judgment to an insurer in its declaratory judgment suit seeking to void a marine policy for material misrepresentations and to deny coverage for the partial sinking of a vessel, finding that the magistrate judge correctly determined that the policy was voided due to an inaccurate answer to a policy application question that was material to the decision to issue the policy.

  • March 03, 2025

    5th Circuit Affirms Dismissal Of Chiropractor’s Claims In Insurance Billing Row

    NEW ORLEANS  — The Fifth Circuit U.S. Court of Appeals on Feb. 28 affirmed a lower court’s dismissal of a chiropractor’s fraud and breach of contract claims against a company with whom she contracted to perform independent medical examinations (IMEs) for workers’ compensation claims, finding that the lower court correctly dismissed the suit because she failed to show an injury in fact related to her claims that the company overbilled insurers for her services.

  • March 03, 2025

    Reinsurer, Agency Dismiss RICO, State Claims In Fraudulent Injury Case

    BROOKLYN, N.Y. — A reinsurer and a management general agency were granted permission by a New York federal court to dismiss claims against an ambulatory surgery center in an ongoing Racketeer Influenced and Corrupt Organizations Act (RICO) lawsuit alleging fraudulent workers’ compensation claims and personal injury lawsuits.

  • February 27, 2025

    5th Circuit Reverses Ruling Denying Judgment To Planned Parenthood In FCA Suit

    NEW ORLEANS  — The Fifth Circuit U.S. Court of Appeals on Feb. 27 reversed and remanded a lower court ruling denying summary judgment to Planned Parenthood for implied false certification and conspiracy claims in a relator’s False Claims Act (FCA) suit accusing Planned Parenthood of failure to repay Medicaid reimbursements received while injunctions were in force in underlying litigation, finding that Planned Parenthood was entitled to summary judgment due to the immunity for its attorneys’ acts.