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Mealey's Insurance Fraud

  • April 17, 2025

    9th Circuit Denies Petition For Panel Rehearing In FCA Medicare Fraud Row

    SAN JOSE, Calif. — In a one-page order without providing explanation, the Ninth Circuit U.S. Court of Appeals denied a petition for panel rehearing of its ruling affirming 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.

  • April 16, 2025

    Insurer’s Motion To Disqualify Insured’s Counsel Granted In Hurricane Damage Row

    NEW ORLEANS — A Louisiana federal magistrate judge on April 15 granted an insurer’s motion to disqualify the insured’s counsel in a dispute over insurance coverage for hurricane damage and purported fraud over the estimates submitted to the insurer, finding in part that a conflict of interest exists due to the close business relationship between one of the insured’s attorneys and a restoration service used by the insured.

  • April 16, 2025

    Michigan Panel Reverses Dismissal Of Insurer In Row Over Auto Claim PIP Benefits

    DETROIT — A Michigan appellate court affirmed a lower court order denying summary disposition to an auto insurer in a personal injury protection (PIP) auto accident dispute but reversed the lower court’s ruling dismissing the PIP-assigned insurer, finding that disputes remain regarding an alleged material misrepresentation in the policy application and whether the son of the insured, who was injured in the accident, is an innocent third party.

  • April 15, 2025

    2nd Circuit Affirms Dismissal Of Qui Tam Suit Against Zocdoc Over Booking Fee

    NEW YORK — The Second Circuit U.S. Court of Appeals on April 14 affirmed a lower court ruling dismissing a qui tam suit alleging violations of the False Claims Act (FCA) against Zocdoc Inc., an internet-based company that enables individuals to search for medical providers, finding that the lower court correctly dismissed the suit and that the complaint failed to allege that Zocdoc acted with the scienter required under the FCA and the Anti-Kickback Statute (AKS) in assessing a booking fee for medical providers.

  • April 14, 2025

    Default Judgment Denied In Declaratory Judgment Suit Over Two $500K Life Policies

    COLUMBUS, Ohio — An Ohio federal judge on April 11 denied an insurer’s motion for default judgment against its insured in a declaratory judgment suit seeking to rescind two $500,000 life insurance policies for the insured’s purported misrepresentations regarding his health history, finding that the insurer failed to address why the insured was appropriately served in the motion for default judgment.

  • April 11, 2025

    3rd Circuit Affirms Dismissal Of FCA Suit Over ‘Hiding’ Antibiotics’ Side Effects

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals on April 10 affirmed a lower court’s dismissal of a qui tam relator’s suit against Bayer Corp., Johnson & Johnson, Merck & Co. and other pharmaceutical companies, alleging that “hiding” side effects of their antibiotics from the U.S. Food and Drug Administration “caused fraudulent claims to be submitted to Medicaid and Medicare,” finding that the relator failed to satisfy the essential elements of a False Claims Act (FCA) violation.

  • April 10, 2025

    Quash Motion Related To False Claims Investigation Denied In Licensure Dispute

    NEW HAVEN, Conn.  — A Connecticut federal magistrate judge denied a motion to quash and for a protective order filed by a dental practice and related parties seeking to stop the enforcement of a dental licensing statute prohibiting dental assistants from using radiology services without required training, finding that the motion to quash a subpoena for documents related to the Connecticut attorney general’s investigation into the practice’s alleged Connecticut False Claims Act violations for claims made to Medicaid “is premature.”

  • April 10, 2025

    Delaware Judge Dismisses 1 Insurer In Coverage Dispute Over Medicaid Fraud Claims

    WILMINGTON, Del. — Three days after an insured and one of its insurers filed a stipulation asking a Delaware court to dismiss with prejudice all claims against the insurer in a professional liability coverage dispute arising from a Medicaid fraud investigation, the judge ordered the case against the insurer dismissed.

  • April 09, 2025

    Panel Reverses, Remands In Row Over Estate’s Alleged Misrepresentations In PIP Row

    DETROIT — In a case on remand from the Michigan Supreme Court, a Michigan appellate court reversed a lower court’s ruling granting summary disposition to an insurer in a personal injury protection (PIP) dispute over whether alleged fraudulent answers to an interrogatory by an estate’s representative constituted material misrepresentations pursuant to Michigan law, finding that issues of fact remain regarding whether the representative knew the answers constituted false information.

  • April 09, 2025

    Magistrate Grants Wells Fargo’s Motion To Withhold Discovery In $300M Ponzi Suit

    MIAMI — A Florida federal magistrate judge granted in part Wells Fargo’s motion to withhold discovery 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).

  • April 08, 2025

    6th Circuit Affirms Dismissal Of Insurance Fraud Suit Absent Injury To Framer

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on April 7 affirmed a lower court’s ruling dismissing a suit filed by a framing subcontractor against a general contractor alleging that the general contractor committed insurance fraud in submitting claims to an insurer based on the subcontractor’s purported breach of contract, finding that the subcontractor failed to allege any injury caused by the purported insurance fraud.

  • April 08, 2025

    Judgment Granted For Insurer In Breach Of Contract Dispute Over $100K Settlement

    LEXINGTON, Ky. — A Kentucky federal judge adopted a magistrate judge’s report and recommendation to grant partial judgment on the pleadings to a homeowners insurer in its breach of contract suit against its insured seeking a return of a $100,000 insurance settlement issued to the insured prior to his insurance fraud conviction, finding that because the parties filed no objections, the court grant will grant the motion and hold that the insured breached the policy.

  • April 07, 2025

    Judgment Denied In Breach Of Contract, Bad Faith Suit Over $70K Life Policy

    ALBANY, Ga. — A Georgia federal judge granted in part and denied in part a motion for summary judgment filed by a life insurer in a breach of contract and bad faith suit against it by the beneficiary of a $70,000 life insurance policy, finding in part that a dispute of facts remains as to whether the decedent made misrepresentations in the policy application.

  • April 04, 2025

    Default Judgment Granted, $212K Policy Rescinded For Alleged Cannabis Use Fraud

    KANSAS CITY, Mo. — A Missouri federal judge granted a life insurer’s motion for default judgment after the insured failed to defend or plead in the insurer’s declaratory judgment suit seeking to rescind and void a $212,000 life insurance policy due to the insured’s alleged fraud regarding his misrepresentation in the policy application about not using marijuana in the last 24 months, which purportedly contradicts his medical records indicating a diagnosis of cannabis dependence.

  • April 04, 2025

    Dismissal Denied For Breach Of Contract Claim Against USAA In Life Policy Dispute

    BOISE, Idaho — An Idaho federal judge granted in part and denied in part USAA’s motion to dismiss in a life insurance beneficiary’s suit against it over USAA’s alleged refusal to pay benefits pursuant to a $750,000 life insurance policy due to purported misrepresentations in the policy application, denying dismissal as to the breach of contract claim because the operative complaint fails to show the misrepresentations were material.

  • April 03, 2025

    Judge: Couple Must Pay More Than $1.9M To Prudential In Long-Term Care Fraud Suit

    ORLANDO, Fla. — After a nine-day jury trial in which a jury issued an award of over $1.9 million to Prudential Insurance in its suit alleging that a Florida couple fraudulently received benefits under their long-term care (LTC) insurance policies, a Florida federal judge issued an order entering judgment in Prudential’s favor, stating that Prudential will recover more than $1.9 million in damages from the couple.

  • April 02, 2025

    3rd Circuit Affirms Ruling Tossing Medicare ‘Fraud’ FCA Suit Against Care Homes

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals on April 1 affirmed a lower court ruling dismissing a qui tam suit filed by a relator on behalf of the U.S. government and multiple states alleging that owners and operators of more than 200 nursing homes operating across the U.S. violated the federal False Claims Act (FCA) by overbilling Medicare and Medicaid, finding that the lower court correctly determined that the relator failed to plead fraud with the specificity required under the Federal Rules of Civil Procedure.

  • April 02, 2025

    Parties Seeks Dismissal Of 1 Insurer In Coverage Dispute Over Medicaid Fraud Claims

    WILMINGTON, Del. — An insured and one of its insurers filed a stipulation asking a Delaware court to dismiss with prejudice all claims against the insurer in a professional liability coverage dispute arising from a Medicaid fraud investigation.

  • April 01, 2025

    Judgment Denied For Insurer In $500K Life Insurance Row Over Suicide Exclusion

    JACKSON, Miss. — A Mississippi federal judge on March 31 granted in part and denied in part a life insurer’s motion for summary judgment in a suit filed by the insured’s family against the life insurer for its refusal to pay the $500,000 death benefit under the policy, finding that the bad faith and punitive damages claims are dismissed absent remaining issues of material fact on those claims.

  • April 01, 2025

    Florida Judge Denies GEICO’s Dismissal Motion In Defamation Suit Over PIP Case

    TAMPA, Fla.  — A Florida federal judge denied GEICO’s dismissal motion in a defamation and tortious interference suit filed against it by a company assisting hospitals with recovery for third-party liability claims under Florida personal injury protection (PIP) law and the company’s owner, finding that dismissal is denied as to the defamation claim because GEICO failed to raise new arguments in earlier dismissal motions and that GEICO failed to “provide a basis” to dismiss the claim for tortious interference.

  • March 31, 2025

    5th Circuit Vacates Judgment Of Over $28M In Vascular Surgery Practice FCA Suit

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on March 28 vacated the final judgment of a district court and remanded for a new trial after the lower court awarded over $28 million against a Texas vascular surgery practice in a qui tam suit alleging that it violated the federal False Claims Act (FCA) when billing Medicare for ultrasound services it did not yet perform.

  • March 28, 2025

    Recommendation For Denial Of Default Judgment Adopted In GEICO PIP Fraud Row

    CENTRAL ISLIP, N.Y. — A New York federal judge adopted a magistrate judge’s report and recommendation advising granting in part and denying in part GEICO’s motion for default judgment against a physician and his medical practices in a declaratory judgment suit over purported fraud regarding more than $95,000 in personal injury protection (PIP) insurance charges for medically unnecessary services, finding no error in the magistrate judge’s recommendation.

  • 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.