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Mealey's Insurance Fraud

  • February 21, 2025

    Judgment As A Matter Of Law Denied In Murdaugh Housekeeper Estate Coverage Row

    CHARLESTON, S.C. — A South Carolina federal judge on Feb. 20 denied a motion for judgment as a matter of law filed by an insurer after a South Carolina jury returned a $1.25 million verdict in favor of the insurer in its suit seeking a declaration that it is entitled to recover the full $3.8 million it paid to settle a claim brought by the estate of Alex Murdaugh’s former housekeeper, finding that though the jury found an attorney liable for violations of state law, the firm where he worked provided evidence that he “acted outside of the scope of his employment.”

  • February 19, 2025

    1st Circuit Affirms Ruling In DOJ ‘First Impression’ FCA Suit Against Regeneron

    BOSTON — The First Circuit U.S. Court of Appeals on Feb. 18 affirmed a lower court ruling granting summary judgment to Regeneron Pharmaceuticals in a U.S. Department of Justice (DOJ) suit alleging violations of the federal False Claims Act (FCA) and the Anti-Kickback Statute (AKS) regarding purported improper funding of the Chronic Disease Fund (CDF) to subsidize patient copays for a Regeneron macular degeneration drug, finding that in this case of “first impression” regarding a 2010 amendment to the AKS, to show falsity under the amendment, the government must prove “that an illicit kickback was the but-for cause of a submitted claim.”

  • February 19, 2025

    After Voluntary Dismissal By Insurers’ Receiver, Judge Tosses $300M Ponzi Case

    MIAMI — After a receiver for insolvent insurers and related entities filed a notice of voluntary dismissal, a Florida federal judge issued a docket-only entry dismissing without prejudice Wells Fargo in the receiver’s suit 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).

  • February 18, 2025

    4th Circuit: First To File Applies, Dismissal Correct In FCA Hospice Fraud Suit

    RICHMOND, Va. — The Fourth Circuit U.S. Court of Appeals on Feb. 14 affirmed a lower court’s dismissal of a qui tam relator’s suit alleging violations of the federal False Claims Act (FCA) by a hospice provider and related entities for improper admissions to hospice, finding that though the lower court should have addressed the amended complaint, it correctly dismissed her claims under the first-to-file rule because of a previously filed similar case against some of the same defendants.

  • February 18, 2025

    Judgment Partially Granted For Homeowner In Row Over More Than $1M In Water Damage

    GREENVILLE, N.C. — A North Carolina federal judge granted in part a homeowner’s motion for judgment on the pleadings in a dispute with her homeowners insurer over its duty to indemnify her for the alleged fraudulently obtained appraisal award of $1,036,000 for the purported water damage to her home, finding that the claim for inclusion of expenses not actually incurred is dismissed for failure to state a claim, but dismissal of all other claims is denied.

  • February 12, 2025

    Partial Judgment Granted To Allstate In Coverage Row Over Fire Damage Claim

    BEAUMONT, Texas — A Texas federal judge partially granted summary judgment to Allstate in a coverage dispute where Allstate says its insured is barred from recovery for fraud in submitting a claim for loss related to the fire he allegedly set at his home, finding that the insured cannot raise a fact dispute on his bad faith and unfair settlement practices counterclaims due to a lack of clarity regarding liability and that he lacks evidence to support his counterclaim for unreasonable delay of payment.

  • February 12, 2025

    Partial Dismissal Granted In Hail Damage Coverage Row Over Roof Tile Replacement

    DENVER — A Colorado federal judge on Feb. 11 granted in part homeowners’ motion to dismiss a misrepresentation counterclaim in a breach of contract suit against their homeowners insurer over the cost to repair their hail-damaged roof, finding that though the counterclaim failed to allege knowing misrepresentation, the homeowners failed to provide any argument to support their request for dismissal with prejudice.

  • February 11, 2025

    Ruling Denying EUO Petition Vacated In Row Over Auto Accident Chiropractic Claims

    FRANKFORT, Ky. — A Kentucky appellate court vacated and remanded a lower court ruling denying Allstate’s petition for an examination under oath (EUO) of individuals involved in an auto accident who sought personal injury protection (PIP) through Allstate for reimbursement for chiropractic medical treatment, finding that the lower court erred in failing to recognize Allstate’s entitlement “to at least inquire into how the accident happened at an EUO.”

  • February 11, 2025

    Depositions Stayed, Intervention Ruling Deferred In GEICO $1M No-Fault Fraud Suit

    BROOKLYN, N.Y. — A New York federal magistrate judge on Feb. 10 deferred ruling on the U.S. government’s motion to intervene but granted its motion to stay depositions for 90 days in a no-fault insurance fraud suit alleging that the defendants, some of whom have been indicted in a related criminal case, participated in a “scheme” to submit to GEICO for payment fraudulent no-fault insurance charges of more than $1 million, finding that the government showed that a stay is warranted but failed to indicate whether the parties consented to intervention.

  • February 11, 2025

    Insurer Seeks To Void Policy Over Prior Policy Cancellation Misrepresentation

    CHICAGO — An Arizona-based insurer sued its insured gym operator seeking to rescind a commercial lines policy based on the insured’s purported misrepresentations in the policy application by not providing information about a lapse in coverage, a nonrenewal due to a history of loss and a cancellation for nonpayment, arguing that the insurer would have issued the policy under different conditions, if at all, if the insured had provided accurate information.

  • February 11, 2025

    Insurer Amends Complaint Against Surgeon In Fraud Suit Alleging ‘False Treatment’

    BROOKLYN, N.Y. — A Vermont-based insurer filed an amended complaint in a New York federal court in its fraud suit against a New York-based spinal surgeon, alleging that he participated in a “scheme” to defraud the insurer by submitting claims for reimbursement regarding “false treatment” and surgeries for injuries purportedly unrelated to incidents covered under the insurer’s policies.

  • February 10, 2025

    Judgment Affirmed For Staffing Agency In Insurance Fraud Prevention Act Dispute

    TRENTON, N.J. — A New Jersey appellate court on Feb. 7 affirmed a lower court’s grant of summary judgment to a medical staffing agency and its parent company in a suit accusing them and related entities and individuals of medical malpractice, negligence and violation of the New Jersey Insurance Fraud Prevention Act (IFPA) related to the role of the agency’s client, an orthopedic provider, in administering knee injections resulting in an infection outbreak, agreeing with the lower court’s determination that the agency had “no role in the formation or operation” of the provider’s practice.

  • February 07, 2025

    Massachusetts Panel Reverses Dismissal Of Auto Coverage Dispute Over Alleged Fraud

    BOSTON — A Massachusetts appellate court reversed a lower court ruling that “allowed” a motion for summary judgment and dismissed an insurer’s suit seeking a judgment that it had no duty to defend its insured for claims brought against her related to an auto accident, finding that the policy exclusion for driving a vehicle not added to the policy applied whether or not the insured made an alleged misrepresentation by failing to report a change in her marital status.

  • February 06, 2025

    Partial Dismissal Of Counterclaims Granted In $3.3M Health Care Fraud Dispute

    ANCHORAGE, Alaska — An Alaska federal judge on Feb. 5 granted in part a motion to dismiss counterclaims in a fraud suit filed by an Alaska health insurer against a California treatment facility alleging approximately $3.3 million of fraudulent claims related to the facility purportedly falsifying income of prospective patients when enrolling them in the health insurer’s plan, finding that the bad faith counterclaims should be dismissed as not adequately pleaded and that there is no private right of action pursuant to an Alaska statute.

  • February 04, 2025

    Del. High Court Affirms Ruling Setting Aside Verdict In Insurance Coverage Dispute

    DOVER, Del. — The Delaware Supreme Court on Feb. 3 affirmed a lower court judge’s ruling granting an insured’s motion for a new trial in a professional liability coverage dispute arising from a Medicaid fraud investigation, finding that the judge did not ignore the law in setting aside a jury verdict.

  • February 03, 2025

    Judgment Of Over $4M Issued In Coverage Row Involving Murdaugh Housekeeper Estate

    CHARLESTON, S.C. — A South Carolina federal court clerk on Jan. 31 filed a judgment reflecting a judge’s orders awarding $3.75 million in treble damages, $289,616.63 in attorney fees and costs of $7,625.72 to an insurer after a South Carolina jury returned a $1.25 million verdict in favor of the insurer in its suit seeking a declaration that it is entitled to recover the $3.8 million it paid to settle a claim brought by the estate of Alex Murdaugh’s former housekeeper.

  • January 31, 2025

    Dismissal Of Policy Fraud Counterclaim Denied In Car Crash Breach Of Contract Suit

    LAS VEGAS — A Nevada federal judge on Jan. 30 denied a motion to dismiss an insurer’s counterclaim seeking a declaration that a misrepresentation or fraud endorsement applies to prevent further payment under a commercial insurance policy in a breach of contract suit filed against the insurer by a man injured in an auto accident, finding that the counterclaim alleges misrepresentations that were material to the insurer’s valuations as to the man’s purported loss of earnings.

  • January 31, 2025

    9th Circuit Affirms Public Disclosure Bar Dismissal In FCA Medicare Fraud Row

    SAN JOSE, Calif. —  The Ninth Circuit U.S. Court of Appeals affirmed a lower court’s dismissal of a qui tam relator’s suit accusing pharmaceutical companies of violating the False Claims Act (FCA) by overcharging the federal government and states under Medicare and Medicaid, finding that the relator waived his argument that the public disclosure bar is inapplicable.

  • January 30, 2025

    Judge Appoints Special Master In Insurance Magnate’s Money Laundering Case

    CHARLOTTE, N.C. — A North Carolina federal judge appointed a special master to assist with restitution that is part of a plea agreement entered into by insurance magnate Greg Lindberg, the former owner of now-insolvent insurers, who pleaded guilty to money laundering conspiracy and conspiracy regarding his $2 billion scheme to defraud insurers and policyholders by funneling money through his extensive global network of insurance companies and was convicted on retrial in a related criminal proceeding.

  • January 29, 2025

    Default Vacated In Insurance Rescission Suit Over Not Disclosing Fraud Indictment

    BROOKLYN, N.Y. — A New York federal judge granted a construction company’s motion to vacate a certificate of default entered by the court after the company failed to timely respond to a suit by its insurer seeking to rescind insurance policies issued to the company for its alleged failure to disclose an indictment for insurance fraud, finding “that the default was not willful” and that “there is clearly no prejudice.”

  • January 27, 2025

    Panel Issues Partial Reversal In Fatal Accident Coverage Row Over Alleged Fraud

    CANTON, Ohio — An Ohio state appellate court reversed in part and remanded a lower court’s ruling granting summary judgment for a commercial insurer in the insurer’s declaratory judgment suit asserting that collision-related losses were not covered under a policy issued to the owner of a used car lot, finding that the lower court erred in granting summary judgment related to fraud or misrepresentation.

  • January 23, 2025

    Government Motion To File Statement Of Interest Granted In FCA Anti-Kickback Suit

    DALLAS — A Texas federal judge granted the U.S. government’s motion to file a statement of interest in a qui tam suit alleging that Texas toxicology laboratories and related parties violated the False Claims Act (FCA), similar state laws and the federal Anti-Kickback Statute (AKS) by obtaining specimens through kickbacks and submitting claims for payment to government insurers, finding that though the government declined to intervene, the FCA does not prevent the court from permitting the government to file a statement of interest.

  • January 21, 2025

    6th Circuit Affirms Dismissal Of FCA Medicare Fraud Suit Against Private Insurers

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals has affirmed a lower court’s dismissal of a qui tam suit filed against more than 300 private insurers, alleging that they violated the federal False Claims Act (FCA) by purportedly making false statements to decrease or avoid payment owed to the government or to a Medicare Advantage organization (MAO), finding that the allegations failed to meet the heightened pleading requirements under the FCA.

  • January 17, 2025

    Bid To Pursue Resolution With Vesttoo Affiliate In Israel Draws Opposition

    WILMINGTON, Del. — Israeli investors’ request for a Delaware federal bankruptcy court to grant relief from the injunction in the Chapter 11 liquidation of Vesttoo Ltd. and dozens of affiliates so they can pursue arbitration and/or liquidation proceedings in Israel has drawn objections that the investors argue should be rejected.

  • January 17, 2025

    Partial Dismissal Recommended In $300M Ponzi Fraud Case Involving Bank, Insurers

    MIAMI — A Florida federal magistrate judge issued a report and recommendation advising granting in part and denying in part motions to dismiss filed by Wells Fargo in a receivership case and a related 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).