Newsletter RSS

Mealey's Insurance Fraud

  • April 09, 2026

    Motion To Bifurcate Hearing Granted In Insurance Magnate Criminal Cases

    CHARLOTTE, N.C. — A North Carolina federal judge granted the parties’ joint motion to bifurcate the sentencing hearing in criminal cases against insurance magnate Greg Lindberg in which he is awaiting sentence and restitution decisions after pleading guilty to money laundering conspiracy and conspiracy related to his $2 billion scheme to defraud insurers and policyholders and after being convicted on retrial in a related criminal proceeding for bribing the North Carolina insurance commissioner.

  • April 08, 2026

    Judge Calls Allegation ‘Conclusory’ In DFS Insurance Fraud Prosecution Dispute

    TAMPA, Fla. — A Florida federal judge on April 7 dismissed without prejudice a negligent investigation claim against the Florida Department of Financial Services (DFS) in a suit filed against it and a DFS law enforcement officer by a roofing salesman alleging that the salesman was wrongfully prosecuted for insurance fraud in a case that was later nolle prossed, finding that the plaintiff failed to assert facts that DFS owed a special tort duty to him and that the allegation related to failure to conduct a diligent investigation “is conclusory.”

  • April 08, 2026

    Magistrate’s Ruling Denying Protective Order Affirmed In Insurance Fraud Dispute

    KNOXVILLE, Tenn. — A Tennessee federal judge affirmed a magistrate judge’s ruling denying a motion for protective order by medical staffing companies in a suit filed by UnitedHealthcare Insurance Co. and related entities alleging that the staffing companies were “upcoding” claims, resulting in millions of dollars in overpayment, finding that the magistrate judge did not err in determining that the companies failed to show that the audit documents at issue should be protected under attorney-client privilege.

  • April 07, 2026

    Washington Law Does Not Allow Insured To Assign Malpractice Claims To Insurer

    SEATTLE — A manufacturer that, along with its insurance company, settled a personal injury lawsuit cannot assign its rights to an alleged legal malpractice claim to its insurer, a Washington appeals panel held April 6 in answering a certified question, finding that there is a potential conflict between the insured and the insurer after the insurer defended the insured pursuant to a reservation of rights to deny coverage.

  • April 07, 2026

    Judge Grants Dismissal Motion In Suit Alleging Billing Fraud At Opioid Clinics

    LAKE CHARLES, La.  — A Louisiana federal judge granted a dismissal motion filed by opioid treatment clinics in a relator’s qui tam suit alleging that they violated the False Claims Act (FCA) and related state law in part by failing to provide adequate therapy services due to staffing inadequacies and submitting bills to government insurers for alleged fraudulent therapy sessions related to purported inaccurate billing, finding in part that the relator failed to plead violations of the FCA “with particularity” as required by the Federal Rules of Civil Procedure.

  • April 06, 2026

    Government Motion To Amend Granted In FCA Suit Alleging Unnecessary Testing

    NASHVILLE, Tenn. — A Tennessee federal judge granted the U.S. government’s motion to amend its complaint in intervention in a suit accusing pain clinics and related parties of violating the False Claims Act (FCA) by billing government insurers for medically unnecessary testing, finding that the defendants failed to show that they would be prejudiced by the court granting the government’s motion or that the motion was made in bad faith.

  • April 03, 2026

    Insurer Seeks To Rescind Commercial Policies Over ‘Material Misrepresentations’

    BROOKLYN, N.Y. — A commercial general liability insurer filed a declaratory judgment suit in a New York federal court against its insured, seeking to rescind two commercial policies and asking the court to declare that it does not owe a duty to defend or indemnify the insured or anyone else involved in any underlying litigation related to the construction of sidewalk sheds due to the insured’s purported misrepresentations in insurance applications regarding the type of work it does.

  • April 02, 2026

    Illinois Panel Affirms Dismissal Of Auto Insurer’s Declaratory Judgment Suit

    CHICAGO — An Illinois appellate court affirmed a lower court’s dismissal of an insurer’s suit seeking a declaration that it did not owe coverage beyond the $25,000 policy limits to its insured, who was involved in an auto accident, ruling that the lower court was correct in finding that the insurer’s alleged bad faith liability regarding past conduct, which relates to a separate bad faith suit, “was more properly considered in the bad faith action.”

  • April 02, 2026

    Lilly: Medicare Drug Rebate False Claims Case Should Be Reviewed By High Court

    CHICAGO — Eli Lilly & Co. urges the U.S. Supreme Court to review a Seventh Circuit U.S. Court of Appeals decision that affirmed a final judgment of $193 million for a qui tam relator who sued Lilly for reporting falsely deflated drug prices to the government in order to profit off of drug rebate programs, arguing in a petition for a writ of certiorari that the case “vividly illustrates the real-world problems with the . . . qui tam regime” under the False Claims Act (FCA).

  • April 01, 2026

    Judgment Granted For Insurer In Suit Over Underlying Wrongful Death Litigation

    SAN JOSE, Calif. — A California federal judge granted an insurer’s motion for default judgment in its declaratory judgment suit against its insured related to underlying wrongful death litigation, finding that under the policy’s business description endorsement, the insurer has no duty to defend and indemnify in the underlying suit and that rescission is appropriate because of “the material misrepresentations” in the insured’s application for insurance.

  • April 01, 2026

    Insurer Seeks Default Judgment Against Boat Crew Member In Policy Rescission Suit

    KEY WEST, Fla. — One day after a Florida federal judge issued an order regarding the procedure to file for default final judgment, a general liability insurer on March 31 filed a motion for default final judgment against a boat crew member in the insurer’s suit seeking a policy rescission for alleged material misrepresentations in a policy renewal application and a declaration that it does not have a duty to defend or indemnify in an underlying negligence action related to a parasailing accident.

  • March 31, 2026

    Judge Tosses Insurance Mogul Bid To Compel Arbitration Related To Equity Purchase

    NEW YORK — A New York federal judge dismissed a suit filed by former insurance mogul Greg Lindberg seeking to compel arbitration to offset claims under an equity purchase agreement (EPA) between an investment company he once owned and sellers who sold their ownership interests in health care and pharmaceutical companies to his investment company, finding that the court lacks personal jurisdiction over any out-of-state defendants, that there is no valid claim for offset and that Lindberg lacks standing to assert claims on behalf of the investment company.

  • March 31, 2026

    Judge Cites 2nd Circuit Cases, Grants Injunction In Allstate No-Fault Fraud Suit

    BROOKLYN, N.Y. — Citing precedent from the Second Circuit U.S. Court of Appeals, a New York federal judge on March 30 granted Allstate’s motion for a preliminary injunction to stay no-fault arbitrations in state court filed by the same medical provider defendants Allstate is suing in federal court over their alleged participation in a no-fault fraud Racketeer Influenced and Corrupt Organizations (RICO) Act scheme, finding that “the risk of irreparable harm” absent a stay tips “the balance of hardships” in favor of Allstate because the outcome of the state court proceedings “could have a preclusive effect” on the federal court’s “ability to provide relief.”

  • March 31, 2026

    Judge Tosses Negligence Claims Against Adjuster Over ‘Inflated’ Hurricane Damage

    SAN JUAN, Puerto Rico — A Puerto Rico federal judge dismissed with prejudice a suit filed by an insurer against an insurance adjuster and his firm, which the Puerto Rico Highway and Transportation Authority hired to adjust claims related to damage from Hurricane Maria, alleging that the defendants negligently misrepresented property damages.  The judge said the case is time-barred by a one-year statute of limitations.

  • March 30, 2026

    U.S. High Court Won’t Review FCA Suit Against Quest Alleging Fraudulent Testing

    WASHINGTON, D.C.  — The U.S. Supreme Court on March 30 denied a qui tam relator’s petition for writ of certiorari asserting that the 11th Circuit U.S. Court of Appeals erred in affirming a lower court order dismissing as lacking in specificity her suit alleging that Quest Diagnostics Inc. violated the False Claims Act (FCA) and similar Georgia law by participating in a fraudulent scheme to order unnecessary laboratory testing that was then billed to government insurers.

  • March 27, 2026

    $60,605 In Attorney Fees Awarded In Policy Voidance Suit Over Murdered Spouse

    PHOENIX — An Arizona federal judge awarded $60,605 in attorney fees to a life insurer in a declaratory judgment suit seeking to void a $750,000 life insurance policy after the insurer paid death benefits to the beneficiary, the deceased insured’s husband, who was later convicted of her murder, finding that the husband had no just defense for failure to respond to the complaint and while the lodestar method to calculate attorney fees was appropriate, the attorney fee request was reduced by the hours of clerical work.

  • March 19, 2026

    Michigan Panel Reverses Dismissal Order In Insurer’s Car Accident Coverage Dispute

    DETROIT — A Michigan appellate court on March 18 reversed and remanded a lower court’s order dismissing a declaratory judgment suit by Progressive Michigan Insurance Co. alleging that it owed no coverage for an accident due to material misrepresentations about the garage locations of the insured vehicle, finding that the lower court abused its discretion when entering a dismissal order after entering a default judgment against certain defendants because the dismissal order prevented State Farm Mutual Automobile Insurance Co., the insurer of another vehicle involved in the accident, “from defending its interests as an interested party.”

  • March 18, 2026

    9th Circuit Reverses Dismissal Of Health System FCA Suit Against Drug Makers

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on March 17 reversed and remanded a lower court’s dismissal of a health system’s qui tam suit asserting violations of the False Claims Act (FCA) and related state laws by drug manufacturers participating in the Public Health Service Act’s Section 340B Drug Pricing Program, finding that because the health system brought an action pursuant to the FCA, the lack of a private right of action under Section 340B was not material and therefore the health system’s claims were not barred by Section 340B.

  • March 17, 2026

    Panel Dismisses Appeal Of Order Vacating Judgment In $150K Life Policy Dispute

    SEATTLE — A Washington state appellate court on March 16 dismissed an appeal by an estate administrator for her son’s estate seeking review of a lower court ruling vacating a default judgment against a life insurance company, finding that the administrator failed to establish standing in her initial complaint to seek death benefits under her son’s $150,000 life insurance policy.

  • March 16, 2026

    Summary Judgment Denied In FCA Suit Against Nursing Home Practitioner Providers

    EAST ST. LOUIS, Ill. — After denying a similar motion for summary judgment in 2023, an Illinois federal judge again denied a motion for summary judgment by companies that provide physician and nurse practitioner services for residents of long-term care (LTC) facilities in a False Claims Act (FCA) suit filed by the government against them, finding that disputes of fact remain regarding the falsity and scienter elements of the FCA.

  • March 13, 2026

    COMMENTARY: America 250: A History Of Insurance And Insurance Coverage Law And Litigation In The United States, Part 1

    By Scott M. Seaman, Pedro E. Hernandez and Peter J. Lewis

  • March 13, 2026

    RICO, Conspiracy Claims Dismissed In Workers’ Comp Case Involving Reinsurer, MGA

    BROOKLYN, N.Y. — A New York federal judge dismissed without prejudice civil Racketeer Influenced and Corrupt Organizations Act (RICO) and RICO conspiracy claims brought by a reinsurer and a managing general agency (MGA) against medical providers and law firms in a workers’ compensation fraud suit, holding that alleged reimbursement and administrative injuries were too remote to establish proximate cause and that the reinsurer and MGA failed to plausibly plead an association-in-fact enterprise or agreement in their first amended complaint.

  • March 12, 2026

    Aetna Settles FCA Allegations Over Medicare Advantage Diagnosis Codes For $117.7M

    PHILADELPHIA — The U.S. Department of Justice on March 11 announced that Aetna Inc. has agreed to pay $117,700,000 to settle a relator’s qui tam suit filed in the U.S. District Court for the Eastern District of Pennsylvania alleging that Aetna and related entities violated the False Claims Act (FCA) by submitting inaccurate diagnosis codes for Aetna members enrolled in its Medicare Advantage plan to increase payments from Medicare.

  • March 12, 2026

    Suit Involving Cousin’s Purported Disability Fraud Is Dismissed As Untimely

    DALLAS — Without substantive explanation, a Texas federal judge overruled objections and accepted a report and recommendation to dismiss as untimely a lawsuit involving fraud and bad faith claims in which the pro se plaintiff challenged a roughly two-decade-old termination of long-term disability (LTD) benefits and alleged that a cousin fraudulently used her identity to file a successful disability claim.

  • March 11, 2026

    2nd Circuit Vacates Judgment For GEICO In $6.6M No-Fault Row With Acupuncturists

    NEW YORK —  The Second Circuit U.S. Court of Appeals on March 10 vacated and remanded a lower court ruling granting GEICO summary judgment on its declaratory judgment, common-law fraud and violation of the Racketeer Influenced and Corrupt Organizations Act (RICO) claims against acupuncture practices and related individuals (collectively, acupuncturists), resulting in a $6,616,142.68 damages award for GEICO, finding that the ruling was based on an inaccurate determination that a health care provider that “improperly buys patient referrals” cannot receive no-fault reimbursements.