Newsletter RSS

Mealey's Insurance Fraud

  • March 12, 2025

    Judge Withdraws Earlier Ruling In Policy Row Over Criminal History Information

    HOUSTON — A Texas federal judge on March 12 withdrew a ruling issued nine days earlier that denied summary judgment to a life insurance policy beneficiary in her suit against the insurer for its failure to pay benefits under the policy, finding that failure to withdraw the earlier ruling was in error because after the insurer filed its amended answer, the judge issued a March 6 ruling that also denied summary judgment to the insured.

  • March 12, 2025

    Allstate Files RICO, Fraud Suit Against Florida Surgery Center And Affiliates

    ORLANDO, Fla. — Allstate filed a suit in a Florida federal court against a Florida surgery center and its affiliates for alleged fraud and federal and state Racketeer Influenced and Corrupt Organizations (RICO) Act violations related to a purported “scheme” committed by the defendants by billing Allstate for medical services that were not performed or were not medically necessary.

  • March 12, 2025

    Special Master Advises Granting Judgment For Insurer In Reverse FCA Medicare Row

    LOS ANGELES  — A special master filed a report and recommendation in a California federal court advising that the court should grant summary judgment to UnitedHealth Group Inc. and its subsidiaries (United) and deny partial summary judgment to the government in its suit accusing United of reverse false claims violations of the federal False Claims Act (FCA) by allegedly “improperly” keeping money paid to it by the government for United’s Medicare Advantage members, finding that the government failed to provide evidence to support its reverse FCA claims.

  • March 11, 2025

    Medical Providers, Insurers Urge 11th Circuit To Affirm Dismissal Of FCA Suit

    ATLANTA — Medical providers and Medicare Advantage (MA) insurers filed an appellee brief on March 10 in the 11th Circuit U.S. Court of Appeals urging the court to uphold a district court’s ruling that dismissed for lack of standing under Article II of the U.S. Constitution a qui tam relator’s suit alleging that the medical providers and MA insurers violated the False Claims Act (FCA).

  • March 07, 2025

    Insurance Mogul Files Response To Summary Judgment In SEC Fraud Suit Against Him

    WINSTON-SALEM, N.C. — Insurance mogul Greg Lindberg, a former owner of insurers in liquidation and rehabilitation, filed in a North Carolina federal court a response to the U.S. Securities and Exchange Commission’s motion for summary judgment in its suit alleging that he, his advisory services company and its former executive defrauded clients of more than $75 million.

  • March 07, 2025

    Jury Issues No Damages Verdict In FCA Suit On Remand From U.S. Supreme Court

    SPRINGFIELD, Ill. — An Illinois federal court jury issued a verdict awarding no damages in a case on remand from the U.S. Supreme Court in which the high court ruled that that pharmacies accused of fraudulently overcharging Medicare, Medicaid and the Federal Employee Health Benefits Program for prescription drugs in violation of the False Claims Act (FCA) “could have the scienter required by the FCA if they correctly understood” the standard of “usual and customary” drug prices when billing Medicare and Medicaid and thought that “their claims were inaccurate.”

  • March 07, 2025

    DOJ Announces $450K Settlement In Medicare Fraud Suit Involving Acupuncture Device

    LAKE CHARLES, La. — Acting U.S. Attorney Alexander C. Van Hook of the U.S. District Court for the Western District of Louisiana on March 6 announced that a physician and his wife who cofounded a medical clinic agreed to pay $450,000 to resolve allegations that they violated the False Claims Act (FCA) by improperly billing Medicare for noncovered electric acupuncture devices.

  • March 07, 2025

    Judgment Granted To Insurer In Suit Over Rescission, Underlying Suit Defense

    NEWARK, N.J. — A New Jersey federal judge granted an insurer’s motion for default judgment in its suit seeking a declaratory judgment that it is entitled to rescind policies issued to its insured contractor and owes no duty to defend or indemnify the contractor in underlying state court litigation, finding “no circumstances that would render the entry of default judgment improper.”

  • March 06, 2025

    Judge Grants Judgment For Insurers In Condominium Attorney Fee Dispute

    NEW YORK — A New York federal judge granted summary judgment for insurers as to a condominium association’s claim for attorney fees in a breach of contract suit filed against insurers over their failure to cover a condominium’s hurricane-related losses, finding that because New York law applies and lacks a provision justifying attorney fee recovery, the claim for attorney fees under Florida law fails.

  • March 05, 2025

    11th Circuit Transfers GEICO Attorney Fee Motion To District Court In Fraud Suit

    ATLANTA — The 11th Circuit U.S. Court of Appeals granted a motion filed by GEICO to transfer its motion for appellate attorney fees to a district court that entered a $690,251.44 judgment for the insurer in its suit against a health care clinic and related parties for allegedly submitting fraudulent no-fault insurance charges.

  • March 05, 2025

    Judgment Denied To Life Policy Beneficiary Over No Incarceration Disclosure

    HOUSTON — A Texas federal judge denied a life insurance policy beneficiary’s motion for summary judgment in her breach of contract suit against an insurer for its failure to pay benefits under the policy, finding that the insurer is entitled to cancel the policy due to the beneficiary’s failure to accurately represent the insured’s criminal history in the policy application.

  • March 03, 2025

    Mich. High Court Won’t Review Ruling Affirming Summary Disposition For Allstate

    LANSING, Mich. — Finding that it was “not persuaded that the questions presented should be reviewed by this Court,” the Michigan Supreme Court denied an auto insurer’s application for leave to appeal a Michigan appellate court’s ruling affirming a lower court’s grant of summary disposition in favor of Allstate Insurance Co. in its suit against the auto insurer, seeking reimbursement for $521,872.82 in personal injury protection (PIP) benefits Allstate paid on behalf of a man fatally injured in a moped accident.

  • March 03, 2025

    Judgment Granted For Insurer In Row Over Sinking Vessel Coverage, Policy Voidance

    MIAMI — A Florida federal judge adopted a magistrate judge’s report and recommendation to grant summary judgment to an insurer in its declaratory judgment suit seeking to void a marine policy for material misrepresentations and to deny coverage for the partial sinking of a vessel, finding that the magistrate judge correctly determined that the policy was voided due to an inaccurate answer to a policy application question that was material to the decision to issue the policy.

  • March 03, 2025

    5th Circuit Affirms Dismissal Of Chiropractor’s Claims In Insurance Billing Row

    NEW ORLEANS  — The Fifth Circuit U.S. Court of Appeals on Feb. 28 affirmed a lower court’s dismissal of a chiropractor’s fraud and breach of contract claims against a company with whom she contracted to perform independent medical examinations (IMEs) for workers’ compensation claims, finding that the lower court correctly dismissed the suit because she failed to show an injury in fact related to her claims that the company overbilled insurers for her services.

  • March 03, 2025

    Reinsurer, Agency Dismiss RICO, State Claims In Fraudulent Injury Case

    BROOKLYN, N.Y. — A reinsurer and a management general agency were granted permission by a New York federal court to dismiss claims against an ambulatory surgery center in an ongoing Racketeer Influenced and Corrupt Organizations Act (RICO) lawsuit alleging fraudulent workers’ compensation claims and personal injury lawsuits.

  • February 27, 2025

    5th Circuit Reverses Ruling Denying Judgment To Planned Parenthood In FCA Suit

    NEW ORLEANS  — The Fifth Circuit U.S. Court of Appeals on Feb. 27 reversed and remanded a lower court ruling denying summary judgment to Planned Parenthood for implied false certification and conspiracy claims in a relator’s False Claims Act (FCA) suit accusing Planned Parenthood of failure to repay Medicaid reimbursements received while injunctions were in force in underlying litigation, finding that Planned Parenthood was entitled to summary judgment due to the immunity for its attorneys’ acts.

  • February 27, 2025

    GEICO Seeks To Recover Over $2.75M In ‘Fraudulent’ PIP Claims From Florida Clinics

    MIAMI — GEICO filed a complaint in a Florida federal court against multiple health care clinics and their owners, seeking to recover over $2.75 million in payments it says were wrongfully obtained for “fraudulent and unlawful” personal injury protection (PIP) claims related to alleged medically unnecessary health care services.

  • February 25, 2025

    Insurer Answers Counterclaim In Suit Over Misrepresentation About Auto Body Shop

    MINNEAPOLIS — A commercial general liability insurer filed an answer to its insureds’ counterclaim in a fire coverage dispute over whether the insurer is entitled to rescind the policy for the insureds’ purported misrepresentation for failure to disclose that an auto body shop operated on their premises.

  • February 21, 2025

    Judgment As A Matter Of Law Denied In Murdaugh Housekeeper Estate Coverage Row

    CHARLESTON, S.C. — A South Carolina federal judge on Feb. 20 denied a motion for judgment as a matter of law filed by an insurer 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 full $3.8 million it paid to settle a claim brought by the estate of Alex Murdaugh’s former housekeeper, finding that though the jury found an attorney liable for violations of state law, the firm where he worked provided evidence that he “acted outside of the scope of his employment.”

  • February 19, 2025

    1st Circuit Affirms Ruling In DOJ ‘First Impression’ FCA Suit Against Regeneron

    BOSTON — The First Circuit U.S. Court of Appeals on Feb. 18 affirmed a lower court ruling granting summary judgment to Regeneron Pharmaceuticals in a U.S. Department of Justice (DOJ) suit alleging violations of the federal False Claims Act (FCA) and the Anti-Kickback Statute (AKS) regarding purported improper funding of the Chronic Disease Fund (CDF) to subsidize patient copays for a Regeneron macular degeneration drug, finding that in this case of “first impression” regarding a 2010 amendment to the AKS, to show falsity under the amendment, the government must prove “that an illicit kickback was the but-for cause of a submitted claim.”

  • February 19, 2025

    After Voluntary Dismissal By Insurers’ Receiver, Judge Tosses $300M Ponzi Case

    MIAMI — After a receiver for insolvent insurers and related entities filed a notice of voluntary dismissal, a Florida federal judge issued a docket-only entry dismissing without prejudice Wells Fargo in the receiver’s suit 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).

  • February 18, 2025

    4th Circuit: First To File Applies, Dismissal Correct In FCA Hospice Fraud Suit

    RICHMOND, Va. — The Fourth Circuit U.S. Court of Appeals on Feb. 14 affirmed a lower court’s dismissal of a qui tam relator’s suit alleging violations of the federal False Claims Act (FCA) by a hospice provider and related entities for improper admissions to hospice, finding that though the lower court should have addressed the amended complaint, it correctly dismissed her claims under the first-to-file rule because of a previously filed similar case against some of the same defendants.

  • February 18, 2025

    Judgment Partially Granted For Homeowner In Row Over More Than $1M In Water Damage

    GREENVILLE, N.C. — A North Carolina federal judge granted in part a homeowner’s motion for judgment on the pleadings in a dispute with her homeowners insurer over its duty to indemnify her for the alleged fraudulently obtained appraisal award of $1,036,000 for the purported water damage to her home, finding that the claim for inclusion of expenses not actually incurred is dismissed for failure to state a claim, but dismissal of all other claims is denied.

  • February 13, 2025

    COMMENTARY: The Top Twelve Insurance Coverage Decisions Of 2024

    By Robert D. Chesler, Seán McCabe, Madilynne Lee and James A. Goodridge

  • February 12, 2025

    Partial Judgment Granted To Allstate In Coverage Row Over Fire Damage Claim

    BEAUMONT, Texas — A Texas federal judge partially granted summary judgment to Allstate in a coverage dispute where Allstate says its insured is barred from recovery for fraud in submitting a claim for loss related to the fire he allegedly set at his home, finding that the insured cannot raise a fact dispute on his bad faith and unfair settlement practices counterclaims due to a lack of clarity regarding liability and that he lacks evidence to support his counterclaim for unreasonable delay of payment.