Mealey's Insurance Fraud : Mealey's : Legal News & Analysis

Mealey's Insurance Fraud

October 30, 2023
9th Circuit Affirms Judgment In Insurance Fraud Dispute Over Employee’s Status

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals issued a corrected opinion, affirming a district court’s summary judgment for an insurance broker acting as a licensed agent for a health insurer awarded $2.4 million in damages when its insured company was found liable for fraud regarding classifying an employee incorrectly as full time, finding, in part, that the district court correctly determined that the broker did not act outside its agency authority for the health insurer.
October 27, 2023
Physician Appeals $27M Judgment In FCA Suit Over ‘Alternative’ Therapy Billing

ROME, Ga. — A physician and his medical practice provided notice to a Georgia federal court that they are appealing to the 11th Circuit U.S. Court of Appeals a $27,567,729 judgment for violations of the False Claims Act (FCA) related to billing Medicare for use of a chelation therapy drug for “alternative” therapy not covered by Medicare after a jury returned a verdict for the U.S. government, finding that all 4,407 claims submitted for reimbursement violated the FCA.
October 26, 2023
Counsel Advises Of Resolution In Commercial Insurance Dispute Over Fire Loss

WILLIAMSPORT, Pa. — Counsel for a property owner suing his commercial property insurer for breach of contract advised a Pennsylvania federal judge that the owner and insurer had resolved the case 11 days after the judge denied certain motions in limine to exclude evidence of purchase and post-fire sale prices of property where a building burned down and the insurer denied coverage, asserting that the fire was intentional.
October 25, 2023
Insurer’s Motion To Exclude Exhibit Granted As To Waiver In Insurance Coverage Row

DAYTON, Ohio — An Ohio federal judge granted in part an insurer’s motion in limine to exclude an exhibit that includes a homeowners policy endorsement, finding that the homeowners may not use the exhibit to argue that the insurer waived a fraud defense because the insurer acted under the endorsement when refusing to cover the homeowners’ additional living expenses (ALE) claim after discovering the homeowners’ alleged fraudulent conduct.
October 24, 2023
Judgment Granted For Lessee In $2.5M Insurance Fraud Row Involving Chris Brown

MEMPHIS, Tenn. — A Tennessee federal judge on Oct. 23 granted summary judgment to the lessee of a recording studio owned by musician Chris Brown, who was previously found liable for submitting a fraudulent insurance claim for burglary and fire at his studio, finding that claim preclusion prevents the insurer from asserting claims against the lessee, who had received a $2.5 million jury award.
October 20, 2023
Partial Dismissal Granted In FCA Suit Against Suboxone Maker Over False Pricing

ABINGDON, Va. — A Virginia federal judge lifted a stay and granted partial dismissal in a relator’s qui tam suit alleging that a suboxone manufacturer violated the federal False Claims Act (FCA) and state law false claims acts by falsely reporting best price data for Suboxone, finding that the FCA claims of misreporting best price, making false statements and retaliation must be dismissed but that the relator’s conspiracy and reverse false claims may proceed.
October 20, 2023
Default Judgment Recommended In Insurance Policy Breach Suit Against Yacht Owner

TAMPA, Fla. — A federal magistrate judge issued a report and recommendation advising that default judgment should be entered against a yacht owner in a maritime insurer’s suit seeking a declaratory judgment that the owner breached an insurance policy, thereby voiding it, finding that the insurer established that “it is entitled to a declaration that the Policy is void” by showing that the owner misrepresented his compliance with recommendations in a yacht survey.
October 18, 2023
Debtors In Vesttoo Chapter 11 Case Ask Bankruptcy Court To Establish Bar Dates

WILMINGTON, Del. — Vesttoo Ltd. and 48 affiliated entities (collectively, the debtors) have asked a Delaware federal bankruptcy court to set a series of bar dates in their jointly administered Chapter 11 case, starting with a Dec. 1 deadline for nongovernmental entities or individuals to file proof of claims that arose before the debtors filed for bankruptcy.
October 17, 2023
2nd Circuit: No Conversion In Case Of 1st Impression Over FCA Medicare Payments

NEW YORK — In a case of first impression on interlocutory appeal, the Second Circuit U.S. Court of Appeals on Oct. 16 reversed and remanded a district court decision denying dismissal to a parent company and its affiliated hospital and nursing home in a qui tam suit alleging violations of the False Claims Act (FCA) related to submitting Medicare and Medicaid reimbursement claims without disclosing alleged unlawful conversions, finding that federal law is not violated when the recipient of a “payment is under no obligation to utilize the funds in any particular way.”
October 17, 2023
$193M False Claims Act Judgment Against Lilly Heads To 7th Circuit On Appeal

CHICAGO — Both parties are appealing a final judgment of $193 million against Eli Lilly & Co. stemming from a False Claims Act jury verdict, with the relator and Lilly suggesting in a joint status report that the Seventh Circuit U.S. Court of Appeals consolidate the proceedings.
October 16, 2023
High Court Won’t Review FCA Suit Alleging Fraudulent Compliance With HUD Rules

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 16 denied a former underwriter’s petition for a writ of certiorari seeking review and reversal of a Seventh Circuit U.S. Court of Appeals’ determination that she failed to show that a lender’s alleged violations of the federal False Claims Act (FCA) caused harm to the U.S. Department of Housing and Urban Development.
October 12, 2023
After 8th Circuit Upholds Ruling In Qui Tam Case, Relators Seek Panel Rehearing

ST. LOUIS — Arguing that an Eighth Circuit U.S. Court of Appeals panel “overlooked facts in the record” and “misapprehended the import” of United States ex rel. Schutte v. SuperValu Inc., relators asked the panel to rehear the qui tam crop insurance case in which a ruling against them was upheld.
October 11, 2023
Washington Panel Affirms Order Denying Surgery In Row Over Workers’ Comp Benefits

SEATTLE — A Washington state appellate court affirmed a lower court order upholding the state Board of Industrial Insurance Appeals’ (BIA) reversal of a Washington Department of Labor (DOL) decision to authorize and pay for surgery related to a man’s purported workplace injury, ruling that the lower court “did not exceed the scope of its review” when entering findings related to the man’s willful misrepresentation.
October 10, 2023
Summary Judgment Granted For GEICO In $3.8M No-Fault Insurance Fraud Suit

MIAMI — A Florida federal judge adopted a magistrate judge’s report and recommendation, granting in part GEICO’s summary judgment motion in a fraud and Racketeer Influenced and Corrupt Organizations Act (RICO) suit filed against a rehabilitation facility, its medical director and related entities, finding that summary judgment for GEICO is appropriate as to its claims related to the medical director’s supervision over health care services at a specified facility.
October 10, 2023
Certiorari Denied In Man’s Bid For Review Of His Insurance Fraud Conviction

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 10 denied a petition for a writ of certiorari filed by a man seeking review of his insurance and tax fraud convictions who said the issuance of a search warrant resulting in his conviction lacked probable cause and violated his rights under the Fourth Amendment to the U.S. Constitution.
October 06, 2023
Magistrate Denies Relator’s Bid To Reopen Discovery In FCA Suit Against Medtronic

KANSAS CITY, Kan. — A Kansas federal magistrate judge on Oct. 5 denied a relator’s request to reopen discovery in his qui tam suit alleging that Medtronic and its related company and a hospital violated the False Claims Act (FCA) by participating in a scheme to provide medically unnecessary treatment resulting in the submission of false claims for payment to federal health care programs, finding that the relator failed to establish good cause to reopen discovery.
October 04, 2023
Judge: First-To-File Bar Inapplicable In FCA Suit Against Skilled Nursing Homes

PHILADELPHIA — A Pennsylvania federal judge denied a motion to dismiss by a therapy service provider and its contracted skilled nursing facilities (SNFs) in a qui tam suit filed against them alleging violations of the False Claims Act (FCA) when they purportedly billed Medicare and Medicaid for unnecessary services, finding that because the suit adds materially to a prior qui tam suit filed against the service provider, the first-to-file rule does not apply to bar the more recent claims.
October 04, 2023
Dismissal Granted In FCA Suit Against Hospitalists For Fraudulent Medicare Billing

CLARKSBURG, W.Va. — A West Virginia federal judge granted dismissal to a hospital and affiliated hospitalists in a qui tam suit filed against them, alleging that they violated the False Claims Act (FCA) by billing Medicare for services that were not actually performed, finding that the relator failed to show that the alleged false claims were submitted to Medicare for payment.
October 04, 2023
Unsecured Creditors In Vesttoo Chapter 11 Case Get Leave To Conduct Discovery

WILMINGTON, Del. — The Official Committee of Unsecured Creditors in the jointly administered Chapter 11 case of Vesttoo Ltd. and 48 affiliated entities has been granted leave by a Delaware federal bankruptcy judge to conduct discovery.
October 02, 2023
Judge Dismisses FCA Claims Against Psychiatric Hospital For Alleged ‘Psych Mill’

BATON ROUGE, La. — A Louisiana federal judge on Sept. 29 dismissed in part without prejudice a relator’s claims that a psychiatric hospital and related officials violated the federal False Claims Act (FCA) in a “psych mill” scheme by allegedly admitting patients based on Medicare coverage rather than medical need and extending Medicare patients’ stays based on purported false diagnoses, finding that the allegations fail to satisfy the materiality and particularity requirements of the FCA.
October 02, 2023
Panel Remands For Insurer To Plead Defenses ‘With Particularity’ In PIP Suit

DETROIT — A Michigan appellate court vacated and remanded a lower court order granting an insurer’s summary disposition motion in a breach of contract suit by its insured, seeking coverage for personal injury protection (PIP) benefits after sustaining injuries incurred in an auto accident, finding that though the insurer “failed to plead with particularity,” the insurer “may amend its affirmative defenses to state its fraudulent misrepresentation defense with particularity.”
September 28, 2023
Certification Request Denied In FCA Suit Over Defective Knee Replacement Devices

TUSCALOOSA, Ala. — An Alabama federal judge denied a motion by an orthopedic device manufacturer to certify for appeal an order denying summary judgment in relators’ suit asserting that the manufacturer violated the federal False Claims Act (FCA) by submitting for reimbursement to government health care programs claims for knee replacement devices it knew were defective, finding that the motion is untimely and will not likely shorten the litigation.
September 27, 2023
8th Circuit Affirms Ruling Against Relators In Qui Tam Crop Insurance Case

ST. LOUIS — In a ruling that drew a partial concurrence, an Eighth Circuit U.S. Court of Appeals panel upheld a challenged ruling in a qui tam crop insurance case, saying in part that “gaps in proof are fatal” to the plaintiffs’ claims under the False Claims Act (FCA).
September 27, 2023
Pa. Federal Judge Dismisses FCA Retaliation Claims By Fired Sleep Study Workers

PHILADELPHIA — While a Pennsylvania federal judge said it was “very unfortunate” that two longtime employees of Abington Memorial Hospital were terminated for “minor infractions” or possible retaliation for reporting that the hospital’s sleep center was using recalled continuous positive air pressure (CPAP) sleep apnea devices and respirators on its patients, the complaint failed to plead that the use could have defrauded the federal government, dooming their False Claims Act (FCA) retaliation claim.
September 27, 2023
Summary Judgment Denied In FCA Suit Against Physicians Providing Nursing Home Care

EAST ST. LOUIS, Ill. — An Illinois federal judge denied motions to strike and for summary judgment in a federal False Claims Act (FCA) suit filed by the government against companies that provide physician and nurse practitioner services for residents of long-term care (LTC) facilities, finding that there is a dispute as to material facts in this case and that the allegations sought to be stricken are relevant to the government’s claims.