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Mealey's Insurance Fraud

  • February 23, 2026

    Pa. False Claims Act Bill Stalls In Senate HHS Committee

    HARRISBURG, Pa. — As of Feb. 23, Pennsylvania House Bill 1697, the Taxpayer Prevention Against Fraud Act sponsored by Rep. Frank Burns (D-Cambria Co.), who describes the bill in a press release as a “state False Claims Act,” remains in the Pennsylvania Senate Health and Human Services Committee where it has been since July 23, after it received final passage in the Pennsylvania House of Representatives on July 9.

  • February 19, 2026

    Magistrate Grants Government’s Medical Records Bid In FCA Suit Over Coding ‘Fraud’

    NEW YORK — A New York federal magistrate judge on Feb. 18 granted the U.S. government’s request for medical records in its suit against Anthem Inc. alleging violations of the False Claims Act (FCA) related to alleged inaccurate diagnosis codes submitted to the Centers for Medicare & Medicaid Services (CMS) for services provided to Anthem’s Medicare beneficiaries, finding that the request is “timely” and that the records “are in fact needed.”

  • February 18, 2026

    Ga. High Court Answers State Law Certified Questions In $6M STOLI Policy Dispute

    ATLANTA — The Georgia Supreme Court on Feb. 17 answered questions certified to it from federal court and held that a third party can be found to have procured a life insurance policy when viewing the “totality of the relevant circumstances” in a trust’s suit seeking to collect death benefits on a $6 million life insurance policy the insurer claims was a stranger-originated life insurance (STOLI) policy that was procured by a third party in violation of Georgia law.

  • February 17, 2026

    N.C. High Court Won’t Stay Contempt Order Requiring Insurance Mogul To Pay $65.7M

    RALEIGH, N.C. — Without providing an explanation, the North Carolina Supreme Court on Feb. 13 denied a motion for a temporary stay of a civil contempt order requiring former insurance mogul Greg Lindberg to pay $65,775,544 and his company to pay $56,901,099 for violating a temporary restraining order (TRO) regarding conversion of assets in insurers’ breach of contract suit against Lindberg, who once owned them, and his company.

  • February 17, 2026

    Calif. Federal Judge Rules On 20 Motions In Limine In Aircraft Insurance Dispute

    SAN DIEGO — A California federal judge granted in part, denied in part and reserved ruling in part on a series of cross-motions in limine in a private jet insurance coverage dispute, excluding evidence of reinsurance and loss reserves, bifurcating punitive damages, limiting expert and regulatory evidence and reserving authentication and hearsay objections to competing insurance proposals for determination at trial.

  • February 12, 2026

    Insurers Ask N.C. Supreme Court To Decline Review Of TRO-Related Contempt Order

    RALEIGH, N.C. — Insurers in liquidation or rehabilitation that were once owned by former insurance mogul Greg Lindberg urged the North Carolina Supreme Court to deny Lindberg and his company’s petition seeking review of a lower court’s civil contempt order for violating a temporary restraining order (TRO) to prevent other entities affiliated with Lindberg and his company from dissipating assets.

  • February 11, 2026

    Judgment On The Pleadings Denied In FCA ‘Fraudulent’ Dermatology Billing Dispute

    PHILADELPHIA — A Pennsylvania federal judge on Feb. 10 denied a company and its affiliated dermatology practices’ motion for judgment on the pleadings or dismissal in a relator’s suit asserting violations of the False Claims Act (FCA) and similar state laws for the practices’ alleged fraudulent billing to receive higher reimbursements from government health insurers, finding that the FCA’s qui tam provisions “did not usurp the executive branch’s control of its enforcement priorities” and the relators’ suit “does not violate the Appointments, Vesting, and Take Care Clauses” of Article II of the U.S. Constitution.

  • February 11, 2026

    Judge Tosses FCA Suit Alleging Billing Fraud Against Life Sciences Company

    NEW YORK — A New York federal judge dismissed with leave to amend a suit alleging violations of the False Claims Act and similar New York state law against a life sciences company for purportedly fraudulently billing government insurers for COVID-19 testing, finding that the relator “failed to allege anything, much less misconduct.”

  • February 11, 2026

    Auto Dealers Claim That Reinsurance Arrangement Included Undisclosed Charges

    SIOUX FALLS, S.D. — A group of vehicle dealerships allege in a South Dakota federal court complaint that they were induced to enter into a reinsurance arrangement marketed as a cost-saving mechanism to vehicle service contracts (VSCs) under which they were charged undisclosed and unauthorized fees across several years, culminating in more than $700,000 in overcharges.

  • February 10, 2026

    Magistrate Recommends No Intervention In GEICO RICO Fraud Suit Against Physician

    BROOKLYN, N.Y. — A New York federal magistrate judge issued a report and recommendation advising against granting intervention to a patient seeking to prevent disclosure of her medical records in a case in which GEICO sued a physician and his practice alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations related to fraudulent no-fault billing, finding that the patient failed to show that her interest in the confidentiality of her records is insufficiently protected.

  • February 09, 2026

    Default Entered, Policy Voided For Misrepresentations In Workers’ Compensation Row

    GREENBELT, Md. — A Maryland federal judge on Feb. 6 granted a motion for default judgment in a workers’ compensation insurer’s suit seeking to rescind a policy issued to a contractor whose employee is seeking workers' compensation benefits, finding that the contractor has failed to appear in this suit and that default judgment is “appropriate in this case.”

  • February 09, 2026

    GEICO Files RICO Suit Against Pharmacy, Owners, Alleging $2.5M In No-Fault Fraud

    BROOKLYN, N.Y. — Government Employees Insurance Co. (GEICO) filed a Racketeer Influenced and Corrupt Organizations Act (RICO) suit against a pharmacy and its owners in New York federal court, alleging that they “exploited the New York ‘No-Fault’ insurance system by submitting approximately $2.5 million in fraudulent pharmaceutical billing to GEICO” related to purported unnecessary topical prescription drugs prescribed for individuals injured in auto accidents and eligible for insurance coverage by GEICO.

  • February 06, 2026

    Judge Grants In Part Judgment For GEICO In No Fault Urine Testing ‘Fraud’ Suit

    BROOKLYN, N.Y. — A New York federal judge granted in part GEICO’s motion for summary judgment in an insurance fraud suit against numerous physicians, nurse practitioners and medical professional corporations who are alleged to have submitted more than $4.5 million in fraudulent no-fault insurance claims, ruling that the court “will issue a declaratory judgement clarifying that GEICO is not obligated to remit payment for” a specified lab’s “billing for unauthorized or medically unnecessary” urine drug testing.

  • February 05, 2026

    Bench, Jury Trial Ordered In Life Insurer’s Rescission Suit Involving Missing Man

    FORT MYERS, Fla. — A Florida federal judge ordered that a bench and a jury trial will be held in a life insurer’s suit seeking a declaration that a man committed suicide and rescission of his $1.4 million life insurance policy due to his purported material misrepresentations in his policy application, finding that a party is entitled to a jury trial in both a breach of contract claim and a declaratory judgment claim but that a rescission claim “is equitable” and subject to a bench trial.

  • February 05, 2026

    Judge Issues Seal Order In FCA Suit Against Pfizer Over Alleged Drug Deficiencies

    NEW YORK — A New York federal judge on Feb. 4 granted a motion to seal by pharmaceutical companies in a relator’s federal False Claims Act (FCA) suit against the companies and Pfizer Inc. over allegedly manufacturing and distributing a drug that fails to meet specifications of the U.S. Food and Drug Administration, finding that the documents sought to be sealed contain research and development information that, if disclosed, could subject one of the companies to “competitive harm.”

  • February 04, 2026

    2nd Circuit Affirms Injunctive Ruling In GEICO RICO Dispute With Medical Providers

    NEW YORK — The Second Circuit U.S. Court of Appeals on Feb. 3 affirmed a lower court ruling granting injunctive relief to GEICO in its Racketeer Influenced and Corrupt Organizations Act (RICO) no-fault fraud suit against medical providers, finding that the lower court did not abuse its discretion in staying the providers’ state court proceedings seeking more than $2 million in judgments against GEICO.

  • February 03, 2026

    Magistrate Orders Parties To Produce Documents In ‘Upcoding’ Insurance Fraud Row

    KNOXVILLE, Tenn. — A Tennessee federal magistrate judge on Feb. 2 granted in part the parties’ discovery requests in a suit filed by UnitedHealthcare Insurance Co. and related entities alleging that medical staffing companies were “upcoding” claims, resulting in millions of dollars in overpayment.

  • February 03, 2026

    Insurer Granted Judgment In ‘Break-Ins’ Misrepresentations Fire Coverage Suit

    FRESNO, Calif. — A California federal magistrate judge granted summary judgment to an insurer in a fire damage coverage dispute with its insured, a veterans services organization, finding that the insurer was entitled to rescind the policy at issue due to material misrepresentations in the policy application regarding vandalism and break-ins at the insured property.

  • January 30, 2026

    Defendants Seek Dismissal Of Federal Crop Insurance Suit Alleging Program Fraud

    RALEIGH, N.C. —  An agricultural operator and several of his family members moved in a North Carolina federal court to dismiss a False Claims Act (FCA) suit alleging a coordinated scheme to defraud federally reinsured crop insurance programs through straw producers, yield shifting and misreported acreage, arguing that the government failed to plead with particularity the submission of any false claims for payment, improperly treated eligibility and insurance documents as actionable claims, asserted time-barred causes of action and did not adequately allege individualized participation supporting liability.

  • January 29, 2026

    Intervention Granted To Insurer In Coverage Dispute Over Misrepresentations

    BROOKLYN, N.Y. — A New York federal judge granted an insurer’s motion for intervention in another insurer’s suit seeking to rescind insurance policies issued to a company for its alleged failure to disclose an indictment for insurance fraud, finding that the insurer seeking intervention satisfied the requirements pursuant to the Federal Rules of Civil Procedure.

  • January 28, 2026

    New Jersey High Court Hears Oral Arguments In Fraud Act Arbitration Dispute

    TRENTON, N.J.  — The New Jersey Supreme Court heard oral arguments in medical providers’ bid to reinstate a trial court’s ruling compelling arbitration of Allstate’s personal injury protection (PIP) claims under the New Jersey Insurance Fraud Prevention Act (the Fraud Act or IFPA) and the New Jersey Anti-Racketeering Act (RICO).

  • January 23, 2026

    Judge Denies Summary Judgment To Insured In Fire Coverage Dispute With State Farm

    EUGENE, Ore.  — An Oregon federal judge denied summary judgment to an insured who sued her homeowners insurer for breach of contract for its alleged failure to cover her fire-related losses, finding that “there is a genuine issue of material fact” whether the insurer, which raised the fraud defense, “detrimentally relied on the alleged misrepresentations” regarding how the fire started.

  • January 23, 2026

    Government Intervenes In FCA Suit Against LTC Hospitals Alleging Medicare Fraud

    SHREVEPORT, La. — The U.S. government filed a complaint in intervention in a Louisiana federal court, alleging that certain Louisiana long-term care hospitals (LTCHs) and a physician violated the federal False Claims Act (FCA) by keeping Medicare patients at their facilities longer than medically necessary to increase the Medicare reimbursement.

  • January 21, 2026

    Stipulation Of Dismissal Filed In FCA Upcoding Suit Pursuant To $556M Settlement

    SAN FRANCISCO — After Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations of False Claims Act (FCA) violations related to false claims for risk adjustment payments under Medicare Advantage, relators and the affiliates in consolidated qui tam suits filed joint stipulations of dismissal.

  • January 20, 2026

    Split Panel Affirms Ruling That Upheld Rescission In PIP Auto Coverage Dispute

    DETROIT — A split Michigan appellate court on Jan. 16 affirmed a lower court’s ruling granting summary disposition to an insurer in an auto accident personal injury protection (PIP) coverage dispute, holding that the lower court did not err in finding that a policy application question regarding driver’s license suspension was not ambiguous and that the insurer was entitled to rescind the policy due to the insured’s material misrepresentation.