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

Mealey's Insurance Fraud

October 02, 2025
Judgment Denied In Hurricane Coverage Row Over Renovation ‘Misrepresentations’

NEW ORLEANS — A Louisiana federal judge denied summary judgment to an insurer in a dispute over insurance coverage for hurricane damage and purported fraud regarding the insured’s alleged material misrepresentations related to property renovations, finding that the court cannot determine “based on the record before it” whether the insured intended to deceive when making the purported misrepresentations.
October 02, 2025
Relator Appeals Dismissal Of FCA Suit Against Publix Super Markets

TAMPA, Fla. — An organization comprising two former Publix Super Markets pharmacists that alleges that the grocery chain violated the False Claims Act (FCA) by knowingly filling prescriptions for opioids and other controlled substances that it knew were improper is appealing to the 11th Circuit U.S. Court of Appeals a decision by a Florida federal judge that dismissed its second amended complaint with prejudice.
October 01, 2025
3rd Circuit Remands For Restitution Assessment In Medicare Fraud Judgment Row

PHILADELPHIA — The Third Circuit U.S. Court of Appeals affirmed in part, vacated in part and remanded a district court’s ruling that restitution obligations were not satisfied in a woman’s appeal related to court-ordered restitution for her role in a Medicare fraud “scheme,” finding that though the lower court “reasonably interpreted” the restitution judgment, it abused its discretion regarding how to count restitution payments.
September 30, 2025
Default Judgment Granted In Dispute Over Marine Policy Coverage For Injured Person

MIAMI — A Florida federal judge granted final default judgment to insurers in a breach of the duty of uberrimae fidei suit against their insured, a company that owns a yacht on which a former employee was purportedly injured, finding that the insurers satisfied the requirements for default judgment and that the policy is void for misrepresentations the insured made regarding not employing persons to work onboard the yacht.
September 30, 2025
Motions For Judgment Denied In Coverage Dispute With Burger King Restaurants Owner

BIRMINGHAM, Ala. — An Alabama federal judge denied summary judgment motions filed by a business insurer and its insured, a company that owns multiple Burger King restaurants, in a coverage dispute over fire damage to a Hoover, Ala., Burger King, finding that summary judgment is denied to the company because it failed to address whether the insurer’s decision not to pay the claim is a breach of the insurance contract.
September 26, 2025
6th Circuit Affirms Ruling In Insurance Row Involving Chris Brown Recording Studio

CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Sept. 25 affirmed a lower court ruling requiring the insurer of a recording studio owned by musician Chris Brown to pay out the majority of a $2.5 million jury verdict to a co-defendant and lessee of the studio after Brown was previously found liable for submitting a fraudulent insurance claim for burglary and fire at the studio, finding in part that the insurer may not challenge the award going to the lessee pursuant to arguments the insurer could have brought previously.
September 24, 2025
Judge Tosses FCA Suit Related To Drug Patent Pursuant To Public Disclosure Bar

BOSTON — A Massachusetts federal judge on Sept. 23 dismissed a qui tam relator’s suit alleging violations of the federal False Claims Act (FCA) and related state laws regarding pharmaceutical companies’ purported fraudulently obtained patents for the drug Xyrem resulting in government health insurers reimbursing Xyrem prescriptions “at inflated prices,” finding that facts in the complaint were previously disclosed and that the public disclosure bar applies.
September 23, 2025
N.J. Panel Affirms Denial Of Insurer’s Motion To Disqualify Insured’s Attorney

TRENTON, N.J. —A New Jersey appeals panel on Sept. 22 affirmed a lower court’s denial of an insurer’s motion to disqualify an insured’s attorney in a coverage dispute over an $772,500 theft claim, rejecting the insurer’s argument that the attorney was a necessary witness for trial and also agreeing with the lower court’s decision to quash the insurer’s subpoena served on the attorney and issue a protective order barring the insurer from seeking the attorney’s disqualification.
September 23, 2025
Michigan Panel Affirms Summary Disposition For Insurer In PIP Coverage Dispute

DETROIT — A Michigan appellate court affirmed a lower court order granting summary disposition to an auto insurer in a personal injury protection (PIP) coverage dispute with its insured, finding that the lower court did not err because the issuance of the policy constituted an injury resulting from material misrepresentations and without the policy being issued, the insurer “would not have been liable for the PIP benefits.”
September 22, 2025
Judgment Granted For Insurer In Dispute Over Rescission, ‘Misrepresentations’

PORTLAND, Maine — A Maine federal judge on Sept. 19 granted summary judgment to an auto insurer sued by its insured alleging breach of contract for the insurer’s failure to cover his auto accident and for rescission of his policy, finding no dispute of material fact related to any of the insured’s claims.
September 18, 2025
2nd Circuit Affirms Ruling Denying Bid To Reopen FCA Suit Based On New Evidence

NEW YORK — The Second Circuit U.S. Court of Appeals on Sept. 17 affirmed a district court order denying a whistleblower physician’s motion to reopen a federal and state false claims act violations suit alleging fraudulent Medicare and Medicaid billing by a health system, finding that the physician failed to show that the health system’s failure to produce the purported newly discovered evidence of a single email was intentional.
September 18, 2025
FCA Retaliation Suit Against Nonprofit Tossed Absent Notice Of Protected Activity

WASHINGTON, D.C. — A District of Columbia federal judge dismissed without prejudice a former employee’s suit alleging that the nonprofit where she worked violated the retaliation provisions of the federal False Claims Act (FCA) by allegedly terminating her employment in retaliation for her complaints about the organization’s purported inaccurate backdating documents to obtain payments from federal health insurers, finding that the woman failed to establish that her former employer knew that she was engaged in protected activity.
September 17, 2025
RICO, Fraud Claims Dismissed In Travelers’ No-Fault Suit Against DME Provider

BROOKLYN, N.Y. — A New York federal judge dismissed Racketeer Influenced and Corrupt Organizations Act (RICO) claims against all defendants and a common-law fraud claim against individual defendants in a suit filed by subsidiaries of Travelers Companies Inc. asserting that a durable medical equipment (DME) manufacturer and related individuals orchestrated a scheme to defraud Travelers by submitting for reimbursement no-fault and workers’ compensation claims that were ineligible for reimbursement, finding in part that Travelers failed to allege that the individuals participated in the purported fraud.
September 17, 2025
Panel Rehearing Bid Fails In LTD Benefits Dispute Involving Jury Verdict

ATLANTA — In a per curiam order issued without explanation in a dispute where a federal jury sided with a long-term disability (LTD) insurer, the 11th Circuit U.S. Court of Appeals denied a petition for panel rehearing, letting stand its ruling vacating a judgment of nearly $450,000 for the insurer on its unjust enrichment claim but upholding dismissal of a breach of contract counterclaim.
September 16, 2025
7th Circuit Affirms $193M Medicare Drug Rebate False Claims Judgment Against Lilly

CHICAGO — The Seventh Circuit U.S. Court of Appeals affirmed a final judgment of $193 million against Eli Lilly & Co. stemming from a False Claims Act jury verdict for reporting falsely deflated drug prices to the government.
September 15, 2025
Magistrate Advises Entering Default, Awarding Over $481K In Insurance Fraud Suit

BROOKLYN, N.Y. — A New York federal magistrate judge on Sept. 12 issued a report and recommendation, advising granting GEICO’s motion for default judgment against a physician and his related entities and entering a judgment of $481,233.13 in compensatory damages against them in GEICO’s suit alleging that multiple providers participated in a scheme to submit fraudulent charges for medically unnecessary services under New York’s no-fault insurance law.
September 15, 2025
Summary Judgment Denied For Insurer In Fabric Water Damage Coverage Dispute

BALTIMORE — A Maryland federal judge denied summary judgment to an insurer in a breach of contract and bad faith suit filed against it by its insured, a “high-end” fabric retailer seeking coverage for water damage, finding that “summary judgment is not appropriate” in part because of remaining questions as to whether the insured voided the policy pursuant to a fraud provision regarding alleged “bogus” estimates of damage.
September 11, 2025
DOJ Subpoena Quashed In Gender Affirming Care Dispute Over Possible FCA Violations

BOSTON — A Massachusetts federal judge denied a motion to seal but granted a motion to quash filed by Boston Children’s Hospital (BCH) regarding a U.S. Department of Justice (DOJ) subpoena seeking information on the hospital’s provision of gender affirming care (GAC), finding that the hospital failed to show “why sealing is required” but that the government failed to “show proper purpose” in its subpoena that was issued the same day as a DOJ civil division memorandum outlining investigations into possible violations of the False Claims Act (FCA) for billing the government for GAC services that are allegedly impermissible.
September 10, 2025
Shepard's Analysis Of FCA Suit Finding Qui Tam Provisions Unconstitutional

As of Sept. 9, 26 federal courts have referenced in their opinions United States ex rel. Clarissa Zafirov v. Physician Partners, LLC, et al., No. 19-1236, M.D. Fla., 2024 U.S. Dist. LEXIS 176626, a ruling currently on appeal in the 11th Circuit U.S. Court of Appeals and tentatively scheduled for oral argument during the week of Dec. 8.
September 09, 2025
Motions To Compel Discovery Granted In Part In Hurricane Coverage Dispute

NEW ORLEANS — A Louisiana federal magistrate judge on Sept. 8 granted in part and denied in part a homeowners insurer’s motions to compel production of documents by an appraiser and his firm in a Hurricane Ida coverage dispute, finding that the appraiser’s contracts for the past 10 years are “relevant.”
September 09, 2025
Dismissal Bid In PIP Dispute Stayed Pending N.J. High Court Arbitration Ruling

BROOKLYN, N.Y. — A New York federal judge stayed a dismissal motion filed by medical providers and related parties in a Racketeer Influenced and Corrupt Organizations (RICO) Act suit accusing them of filing fraudulent claims for payment for persons allegedly involved in auto accidents and covered under GEICO no-fault or personal injury protection (PIP) policies, finding that a stay is appropriate because the motion relates to the New Jersey Supreme Court’s grant of certification addressing the applicability of arbitration to insurance fraud claims under New Jersey law.
September 08, 2025
Citing ‘Troubling’ Conduct, Judge Awards Attorney Fees In Billing ‘Fraud’ Suit

BOSTON — A Massachusetts federal judge “allowed” a motion for attorney fees filed by a lab and its owners in a medical practice’s 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 “extremely troubling” the relator’s conduct regarding causing the submission of false claims while knowing that testing was not medically necessary.
September 05, 2025
7th Circuit Affirms FCA Suit Dismissal, Says No Retaliation Due To Absence Of Fraud

CHICAGO — The Seventh Circuit U.S. Court of Appeals affirmed a lower court’s order dismissing a False Claims Act (FCA) suit filed by a man against AbbVie Inc. regarding alleged fraud for off-label use of a medication for a government-insured patient and retaliation against the plaintiff as a whistleblower, finding that “AbbVie could not have retaliated against” the man as a whistleblower because he did not blow the whistle on fraud.
September 03, 2025
High Court Denies Motion To Stay Fund Disbursement In Insurance Fraud Dispute

WASHINGTON, D.C. — The U.S. Supreme Court denied a company’s motion to stay a district court order to disburse $650,000 in funds purportedly belonging to a nonparty almost four months after that company, whose former owner was convicted in an insurance fraud scheme and over which a limited liability company (LLC) obtained an insurance fraud judgment, sought U.S. Supreme Court review of a 10th Circuit U.S. Court of Appeals decision affirming an Oklahoma federal court ruling granting summary judgment in favor of the LLC.
September 03, 2025
After Stipulation, Judge Dismisses GEICO PIP Suit Against Chiropractic Providers

ORLANDO, Fla. — After the parties filed a joint stipulation of dismissal, a Florida federal judge dismissed GEICO’s suit seeking to recover more than $1.29 million for alleged fraudulent personal injury protection (PIP) insurance charges from a nurse and the physical therapy and chiropractic services providers she owned for allegedly providing medically unnecessary and upcoded services.