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Mealey's Insurance Fraud

  • December 20, 2024

    State Appellate Court Accepts Certification Question In $6.6M No-Fault Dispute

    NEW YORK —  Without providing explanation, a New York state appellate court has accepted a bid for certification of a question by the Second Circuit U.S. Court of Appeals as to an insurer’s ability to deny no-fault benefit payments to a health care provider upon finding improper payments for patient referrals in health care providers’ appeal of a district court’s ruling granting judgment for GEICO and awarding it $6,616,142.68 in damages in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit over purported fraudulent no-fault automobile insurance reimbursement.

  • December 19, 2024

    Magistrate Recommends Awarding Over $173K In Damages In No-Fault Fraud Suit

    CENTRAL ISLIP, N.Y. — A New York federal magistrate judge issued a report and recommendation advising that Allstate’s motion for default judgment should be granted and that Allstate be awarded damages of $173,339.51 in its no-fault fraud suit against a physician and his related practices regarding a purported scheme to create clinics for the sole purpose of submitting no-fault claims, finding that Allstate satisfied the requirements “to establish a claim for common law fraud” and “is entitled to recover the amounts it seeks in compensatory damages.”

  • December 19, 2024

    Summary Judgment Denied For Couple In $1M Long-Term Care Insurance Fraud Dispute

    ORLANDO, Fla.  —  A Florida federal judge denied a motion for summary judgment filed by a couple in Prudential Insurance’s declaratory judgment suit against them seeking to rescind their long-term care (LTC) insurance policies due to the more than $1 million in benefits they allegedly received by purportedly misrepresenting their health and eligibility, finding that disputes of fact remain regarding whether their misrepresentations were fraudulent.

  • December 18, 2024

    2 Investors Want To Pursue Resolution With Vesttoo Affiliate In Israel

    WILMINGTON, Del. — Two Israeli investors have asked a Delaware federal bankruptcy court for relief from the injunction in the Chapter 11 liquidation of Vesttoo Ltd. and its dozens of affiliates so they can pursue arbitration and/or liquidation proceedings in Israel.

  • December 17, 2024

    Judge Grants Motion To Compel In GEICO’s PIP Suit Against Chiropractic Center

    NEWARK, N.J. — A New Jersey federal judge granted a motion to compel arbitration filed by a chiropractic center and its chiropractor in a suit alleging that the defendants submitted to GEICO for payment fraudulent personal injury protection (PIP) claims, finding that a valid arbitration agreement exists and that the defendants did not waive their right to seek arbitration.

  • December 17, 2024

    GEICO Moves To Transfer Attorney Fee Issues To District Court In Fraud Suit

    ATLANTA — GEICO filed a motion in the 11th Circuit U.S. Court of Appeals to transfer its motion for appellate attorney fee consideration to a district court in its suit against a health care clinic and related parties for allegedly submitting fraudulent no-fault insurance charges, arguing that because the lower court will be considering GEICO’s motion for attorney fees, “judicial economy” will be served by having only the district court “analyze the attorney’s fee issue.”

  • December 17, 2024

    Judge Stays Discovery In Lawsuit Over Alleged Workers’ Comp Scheme

    BROOKLYN, N.Y. — A New York federal judge has stayed discovery pending resolution of expected dismissal motions in a Racketeer Influenced and Corrupt Organizations Act (RICO) lawsuit where a reinsurer and management general agency allege that the defendants took part in purportedly fraudulent workers’ compensation claims and personal injury lawsuits.

  • December 11, 2024

    Magistrate Judge Terminates New Jersey Statutory Insurance Fraud Suit

    CAMDEN, N.J. — In a one-page order without explanation, a New Jersey federal magistrate judge on Dec. 10 issued a 90-day order administratively terminating an insurer’s fraud suit against its insured related to violations of the New Jersey Insurance Fraud Prevention Act concerning the number of vehicles the insured owned.

  • December 11, 2024

    Life Insurer Seeks $250K Policy Rescission Over Alleged Health Misrepresentation

    ROCK HILL, S.C. — A Massachusetts-based life insurer filed a complaint in a South Carolina federal court against a South Carolina man to whom it issued a $250,000 term life policy, seeking to void the policy for an alleged material misrepresentation the man made regarding his health in the policy application.

  • December 10, 2024

    Panel Reverses Grant Of Summary Disposition In PIP Row Over Policy Application

    DETROIT — A Michigan appeals court reversed a lower court’s grant of summary disposition in a breach of contract suit filed by a woman against her insurer for its purported refusal to cover her injuries from an auto accident pursuant to a personal injury protection (PIP) claim, finding that a dispute of material fact remains regarding whether the woman made a material misrepresentation on her insurance policy application as to “whether she is the registrant of another vehicle that is not separately insured.”

  • December 10, 2024

    Bank, Related Entities Face Another Suit Connected To Vesttoo Collapse

    NEW YORK — China Construction Bank Corp. (CCBC) and related entities are facing yet another lawsuit in connection with the collapse of Vesttoo Ltd., with plaintiffs asserting breach of contract and alternative claims in New York federal court.

  • December 05, 2024

    Stipulation Of Dismissal Filed In GEICO RICO Suit Against North Carolina Doctors

    CHARLOTTE, N.C. —  Without providing explanation, GEICO filed a stipulation of dismissal in a North Carolina federal court, agreeing to dismiss with prejudice claims alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations, fraud and unjust enrichment against a North Carolina physician and his medical practice for a purported “scheme” to submit to GEICO for payment of claims for unnecessary or not performed medical services for persons injured in auto accidents involving GEICO insureds.

  • December 04, 2024

    3rd Circuit Affirms Public Disclosure Bar Dismissal Of FCA Arteriogram Suit

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals on Dec. 3 affirmed a district court’s ruling dismissing a qui tam plaintiff’s suit against a vascular surgeon and his medical practice, alleging violations of the federal False Claims Act (FCA) for submitting purported false claims for reimbursement to Medicare and Medicaid regarding lack of patient consent for arteriograms performed in an office rather than an ambulatory surgery center (ASC), finding that the district court correctly held that the claims were “precluded by the public disclosure bar.”

  • December 03, 2024

    Discovery Rulings Issued In FCA Suit Over Alleged Cyber-Distracted Anesthesiologists

    SALT LAKE CITY — A Utah federal magistrate judge granted in part motions to stay depositions filed by defendant anesthesiologists and their practices in a qui tam suit asserting that they violated the False Claims Act (FCA) and a similar Nevada law by submitting for payment to government insurers claims for anesthesiology services when they were instead allegedly “immersed in the Internet” rather than providing care to their patients during surgery.

  • November 27, 2024

    Judgment Denied To Insurer, Insured In Multifamily Dwelling Fire Loss Dispute

    BROOKLYN, N.Y. — A New York state court justice denied summary judgment motions filed by an insurer and an insured in a dispute over coverage for a fire-related loss occurring at a tenant-occupied dwelling, finding that questions of fact remain regarding the existence of material misrepresentations in the insurance policy application.

  • November 26, 2024

    Judge Grants Motion To Strike Misrepresentation Defense In Hailstorm Coverage Row

    DENVER — A Colorado federal judge on Nov. 25 granted a homeowner’s motion to strike her insurer’s affirmative defense related to voiding her policy for purported misrepresentation in the homeowner’s bad faith suit against the insurer for alleged failure to cover hail damage, finding that the defense fails to meet the pleading requirements for particularity under the Federal Rules of Civil Procedure.

  • November 26, 2024

    Pharma Company To 9th Circuit: Relator Not Original Source In FCA Medicare Fraud Row

    SAN JOSE, Calif.  — Adamas Pharma LLC and Adamas Pharmaceuticals Inc. (collectively, Adamas) filed a citation of supplemental authority in the Ninth Circuit U.S. Court of Appeals one day after the court heard oral argument in a qui tam relator’s appeal of a district court’s ruling finding the public disclosure bar applicable and dismissing his claims that pharmaceutical companies violated the False Claims Act (FCA) by overcharging the federal government and states under Medicare and Medicaid.

  • November 22, 2024

    Tennessee Judge: Hospital Can’t Amend Answer To Claim FCA Is Unconstitutional

    CHATTANOOGA, Tenn. — A Tennessee federal judge denied in part a hospital and health system’s motion to amend an answer to a complaint to assert affirmative defenses in a qui tam suit accusing them of violating the federal False Claims Act (FCA) and a similar state law, finding that the defense of the FCA’s unconstitutionality pursuant to a recent ruling in a Florida federal court, “is plainly futile.”

  • November 22, 2024

    U-Haul Sues Lessee Over Accident ‘Staged’ For Loss Under $1M Liability Policy

    LOS ANGELES — U-Haul Co. of California (UHCA) filed a breach of contract suit in California state court against the lessee of one of its rental trucks and other persons it says are involved in a “scheme” where they purportedly staged an accident with the truck and a vehicle to fraudulently assert claims for property damage and personal injury pursuant to the $1 million supplemental liability insurance coverage available on the U-Haul truck.

  • November 22, 2024

    Judge: Parties Not Entitled To Judgment In Row Over Coverage For Malpractice Suit

    NEWARK, N.J. — A New Jersey federal judge denied motions for summary judgment filed by an obstetrician-gynecologist and the insurer he sued seeking a declaration that he is entitled to coverage in an underlying state court medical malpractice case, finding that issues of fact remain regarding whether the physician intentionally omitted in his insurance application information about the delivery of a baby that might result in litigation.

  • November 22, 2024

    New York Care Homes Sued By Attorney General Settle Medicare Fraud Suit For $45M

    NEW YORK — New York Attorney General Letitia James announced that multiple nursing homes and their owners and operators sued in the New York County Supreme Court have agreed to pay $45 million to settle a suit against them alleging understaffing and resident neglect, as well as fraud and misuse of Medicare and Medicaid funds.

  • November 21, 2024

    Panel: Recission Demands 1st Made Before Policy Inception, No D&O Coverage Owed

    ATLANTA — The 11th Circuit U.S. Court of Appeals on Nov. 20 held that an insurer has no duty to provide directors and officers liability coverage for investors' rescission demands against its insured because the claims were first made before the policy’s inception, agreeing with the lower court’s ultimate judgment in favor of the insurer but vacating and remanding for the lower court to amend the judgment to rest on a theory of exclusion and not recission.

  • November 19, 2024

    Insurer Denied Judgment In Flood Damage Fraud Dispute Over Contractor Invoices

    BROOKLYN, N.Y. — A New York federal judge denied a homeowners insurer’s motion for summary judgment in a breach of contract suit filed against it regarding the insurer’s purported failure to cover its insured’s flood damage losses, finding that disputes of fact remain on whether contractor’s invoices submitted to the insurer were fraudulent.

  • November 14, 2024

    2nd Circuit Certifies Question To State Court In $6.6M No-Fault Payment Dispute

    NEW YORK —  The Second Circuit U.S. Court of Appeals certified to the New York Court of Appeals a question regarding an insurer’s ability to deny no-fault benefit payments to a health care provider upon finding improper payments for patient referrals in health care providers’ appeal of a district court’s ruling granting judgment for GEICO and awarding it $6,616,142.68 in damages in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit over purported fraudulent no-fault automobile insurance reimbursement.

  • November 13, 2024

    U.S. High Court Declines Review Of FCA Suit Against Allstate Over Medicare Claims

    WASHINGTON, D.C. — The U.S. Supreme Court on Nov. 12 denied a petition for a writ of certiorari filed by the owner of health care businesses and a related party seeking review of a Sixth Circuit U.S. Court of Appeals’ ruling affirming a district court’s dismissal based on the public disclosure bar of a qui tam suit alleging violations of the False Claims Act (FCA) regarding Allstate Insurance Co.’s alleged defrauding of Medicare related to claims for injuries incurred in auto accidents.