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Mealey's Insurance Fraud

  • 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).

  • January 16, 2025

    Sanctions Sought For Alleged Text Messages Destruction In Insurance Coverage Row

    MINNEAPOLIS — Great American Insurance Co. (GAIC) filed a motion in a Minnesota federal court seeking sanctions related to the purported destruction of text messages by its insured, a Minneapolis event center, in the insurer’s suit seeking a declaration that it does not need to pay an appraisal award of $986,436 related to business income loss the insurer says was based upon “concealed and misrepresented material facts and circumstances willfully and with intent to defraud.”

  • January 14, 2025

    United Healthcare Granted Relief From Judgment In Oncology Drugs Fraud Dispute

    MINNEAPOLIS — A Minnesota federal judge granted relief from judgment to United Healthcare Services Inc., a subsidiary of UnitedHealth Group Inc., in its suit accusing a drug manufacturer of participating in a “scheme” to repackage and sell oncology drugs to second purchasers resulting in excessive billing to health care insurers, finding that the proposed amended complaint “plausibly raises the existence of factual disputes related to the timeliness of its claims.”

  • January 14, 2025

    New Jersey Panel Says Claims Under Fraud Act, RICO Not Subject To Arbitration

    TRENTON, N.J. — A New Jersey appellate court reversed and vacated and remanded a lower court’s orders compelling to personal injury protection (PIP) arbitration Allstate’s declaratory judgment claims under the New Jersey Insurance Fraud Prevention Act (the Fraud Act) and the New Jersey Anti-Racketeering Act (RICO), finding that the New Jersey Supreme Court has upheld the right to a jury trial in Fraud Act claims and under New Jersey law, RICO plaintiffs “have a right to a jury trial.”

  • January 14, 2025

    Motion To Exclude Testimony Granted In $1M Long-Term Care Insurance Fraud Dispute

    ORLANDO, Fla. — A Florida federal judge granted in part a couple’s motion to exclude expert testimony pursuant to Daubert v. Merrell Dow Pharmaceuticals Inc. 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 some of the testimony by an insurance claims consultant must be excluded because it contains “inadmissible legal conclusions.”

  • January 10, 2025

    Judge Awards Insurer $3.75M In Coverage Row Involving Murdaugh Housekeeper Estate

    CHARLESTON, S.C. — A South Carolina federal judge on Jan. 9 issued an order awarding $3.75 million in treble damages to an insurer one day 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 10, 2025

    New Jersey Panel Affirms Judgment For Allstate In Row Over Auto Accident Coverage

    TRENTON, N.J. — A New Jersey appellate court affirmed a lower court’s ruling granting summary judgment to Allstate in a dispute with its insured’s brother, who was seeking underinsured motorist (UIM) coverage for alleged injuries sustained in an auto accident while driving the insured’s vehicle, finding that the lower court did not err in granting summary judgment or in denying reconsideration due to the insured’s failure to notify Allstate of his brother’s residency at the insured’s dwelling.

  • January 09, 2025

    Judgment Issued For Oil Company In Dispute Over Hurricane-Damaged Oil Barge

    HOUSTON — A Texas federal judge on Jan. 8 granted in part summary judgment to a gas and oil exploration company in its breach of contract suit against its insurer for failure to cover costs for recovering an oil barge damaged and set adrift during Hurricane Ida, finding that because there is no dispute that removal of the barge was required under law, the protection and indemnity (P&I) policy applies.

  • January 07, 2025

    Judge Grants Judgment For Defendants In Suit Alleging Fraud in UTI Test Billing

    BOSTON — A Massachusetts federal judge on Jan. 6 “allowed” a motion for summary judgment filed by a lab and its owners in a qui tam suit alleging that they violated the False Claims Act (FCA) and similar state laws related to billing federal government insurers for medically unnecessary urinary tract infection (UTI) testing, finding that the allegations fail to show that the defendants knew they were submitting claims for unnecessary UTI testing.

  • January 06, 2025

    Panel Affirms Workers’ Comp Order Denying Insurer’s Petition To Terminate Benefits

    HARRISBURG, Pa.  — A Pennsylvania appellate court on Jan. 3 affirmed a ruling by the Pennsylvania Workers’ Compensation Appeal Board affirming a workers’ compensation judge’s decision denying an insurer’s petitions to review and terminate workers’ compensation benefits paid to a worker injured in a fall through a roof, agreeing with the board that the insurer failed to show that the employer “knowingly made false statements” to obtain insurance.

  • January 06, 2025

    11th Circuit Denies Insured’s Petition For Rehearing In D&O Coverage Dispute

    ATLANTA — An 11th Circuit U.S. Court of Appeals panel denied an insured’s petition to reconsider its finding that an insurer has no duty to provide directors and officers liability coverage for investors' rescission demands against the insured because the claims were first made before the policy’s inception, standing by its ruling that agreed with a lower court’s judgment in favor of the insurer but vacated and remanded for the lower court to amend the judgment so it is based on a theory of exclusion and not recission.

  • January 02, 2025

    10th Circuit Affirms Judgment For LLC In $6.7M Insurance Portfolio Garnishment Row

    DENVER — The 10th Circuit U.S. Court of Appeals on Dec. 31 affirmed an Oklahoma federal court ruling re-entering summary judgment in favor of a limited liability company (LLC) seeking to garnish a $6.7 million insurance portfolio held by an entity owned by a company over which the LLC obtained an insurance fraud judgment in a New York federal court, finding that the Oklahoma federal court correctly retained jurisdiction during the appeal of a prior summary judgment order and correctly reaffirmed summary judgment after receiving a mandate from the appellate court.

  • January 02, 2025

    2nd Circuit Vacates In FCA Case Of First Impression Over Alleged Drug Kickbacks

    NEW YORK — The Second Circuit U.S. Court of Appeals vacated and remanded in part a district court’s ruling dismissing a qui tam plaintiff’s complaint alleging that Novartis Pharmaceuticals Corp. violated the federal False Claims Act (FCA) by engaging in kickbacks in violation of the federal Anti-Kickback Statute (AKS) through offering “illicit renumeration” to physicians prescribing the multiple sclerosis drug Gilenya, finding “as a matter of first impression in this Circuit that a plaintiff states an AKS violation so long as she alleges with the requisite particularity that at least one purpose of the purported scheme was to induce fraudulent conduct.”

  • 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.”