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

Mealey's Insurance Fraud

December 10, 2024
Panel Reverses Grant Of Summary Disposition In PIP Row Over Policy Application

DETROIT — A Michigan appeals court reversed a lower court’s grant of summary disposition in a breach of contract suit filed by a woman against her insurer for its purported refusal to cover her injuries from an auto accident pursuant to a personal injury protection (PIP) claim, finding that a dispute of material fact remains regarding whether the woman made a material misrepresentation on her insurance policy application as to “whether she is the registrant of another vehicle that is not separately insured.”
December 10, 2024
Bank, Related Entities Face Another Suit Connected To Vesttoo Collapse

NEW YORK — China Construction Bank Corp. (CCBC) and related entities are facing yet another lawsuit in connection with the collapse of Vesttoo Ltd., with plaintiffs asserting breach of contract and alternative claims in New York federal court.
December 05, 2024
Stipulation Of Dismissal Filed In GEICO RICO Suit Against North Carolina Doctors

CHARLOTTE, N.C. — Without providing explanation, GEICO filed a stipulation of dismissal in a North Carolina federal court, agreeing to dismiss with prejudice claims alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations, fraud and unjust enrichment against a North Carolina physician and his medical practice for a purported “scheme” to submit to GEICO for payment of claims for unnecessary or not performed medical services for persons injured in auto accidents involving GEICO insureds.
December 04, 2024
3rd Circuit Affirms Public Disclosure Bar Dismissal Of FCA Arteriogram Suit

PHILADELPHIA — The Third Circuit U.S. Court of Appeals on Dec. 3 affirmed a district court’s ruling dismissing a qui tam plaintiff’s suit against a vascular surgeon and his medical practice, alleging violations of the federal False Claims Act (FCA) for submitting purported false claims for reimbursement to Medicare and Medicaid regarding lack of patient consent for arteriograms performed in an office rather than an ambulatory surgery center (ASC), finding that the district court correctly held that the claims were “precluded by the public disclosure bar.”
December 03, 2024
Discovery Rulings Issued In FCA Suit Over Alleged Cyber-Distracted Anesthesiologists

SALT LAKE CITY — A Utah federal magistrate judge granted in part motions to stay depositions filed by defendant anesthesiologists and their practices in a qui tam suit asserting that they violated the False Claims Act (FCA) and a similar Nevada law by submitting for payment to government insurers claims for anesthesiology services when they were instead allegedly “immersed in the Internet” rather than providing care to their patients during surgery.
November 27, 2024
Judgment Denied To Insurer, Insured In Multifamily Dwelling Fire Loss Dispute

BROOKLYN, N.Y. — A New York state court justice denied summary judgment motions filed by an insurer and an insured in a dispute over coverage for a fire-related loss occurring at a tenant-occupied dwelling, finding that questions of fact remain regarding the existence of material misrepresentations in the insurance policy application.
November 26, 2024
Judge Grants Motion To Strike Misrepresentation Defense In Hailstorm Coverage Row

DENVER — A Colorado federal judge on Nov. 25 granted a homeowner’s motion to strike her insurer’s affirmative defense related to voiding her policy for purported misrepresentation in the homeowner’s bad faith suit against the insurer for alleged failure to cover hail damage, finding that the defense fails to meet the pleading requirements for particularity under the Federal Rules of Civil Procedure.
November 26, 2024
Pharma Company To 9th Circuit: Relator Not Original Source In FCA Medicare Fraud Row

SAN JOSE, Calif. — Adamas Pharma LLC and Adamas Pharmaceuticals Inc. (collectively, Adamas) filed a citation of supplemental authority in the Ninth Circuit U.S. Court of Appeals one day after the court heard oral argument in a qui tam relator’s appeal of a district court’s ruling finding the public disclosure bar applicable and dismissing his claims that pharmaceutical companies violated the False Claims Act (FCA) by overcharging the federal government and states under Medicare and Medicaid.
November 22, 2024
Tennessee Judge: Hospital Can’t Amend Answer To Claim FCA Is Unconstitutional

CHATTANOOGA, Tenn. — A Tennessee federal judge denied in part a hospital and health system’s motion to amend an answer to a complaint to assert affirmative defenses in a qui tam suit accusing them of violating the federal False Claims Act (FCA) and a similar state law, finding that the defense of the FCA’s unconstitutionality pursuant to a recent ruling in a Florida federal court, “is plainly futile.”
November 22, 2024
U-Haul Sues Lessee Over Accident ‘Staged’ For Loss Under $1M Liability Policy

LOS ANGELES — U-Haul Co. of California (UHCA) filed a breach of contract suit in California state court against the lessee of one of its rental trucks and other persons it says are involved in a “scheme” where they purportedly staged an accident with the truck and a vehicle to fraudulently assert claims for property damage and personal injury pursuant to the $1 million supplemental liability insurance coverage available on the U-Haul truck.
November 22, 2024
Judge: Parties Not Entitled To Judgment In Row Over Coverage For Malpractice Suit

NEWARK, N.J. — A New Jersey federal judge denied motions for summary judgment filed by an obstetrician-gynecologist and the insurer he sued seeking a declaration that he is entitled to coverage in an underlying state court medical malpractice case, finding that issues of fact remain regarding whether the physician intentionally omitted in his insurance application information about the delivery of a baby that might result in litigation.
November 22, 2024
New York Care Homes Sued By Attorney General Settle Medicare Fraud Suit For $45M

NEW YORK — New York Attorney General Letitia James announced that multiple nursing homes and their owners and operators sued in the New York County Supreme Court have agreed to pay $45 million to settle a suit against them alleging understaffing and resident neglect, as well as fraud and misuse of Medicare and Medicaid funds.
November 21, 2024
Panel: Recission Demands 1st Made Before Policy Inception, No D&O Coverage Owed

ATLANTA — The 11th Circuit U.S. Court of Appeals on Nov. 20 held that an insurer has no duty to provide directors and officers liability coverage for investors' rescission demands against its insured because the claims were first made before the policy’s inception, agreeing with the lower court’s ultimate judgment in favor of the insurer but vacating and remanding for the lower court to amend the judgment to rest on a theory of exclusion and not recission.
November 19, 2024
Insurer Denied Judgment In Flood Damage Fraud Dispute Over Contractor Invoices

BROOKLYN, N.Y. — A New York federal judge denied a homeowners insurer’s motion for summary judgment in a breach of contract suit filed against it regarding the insurer’s purported failure to cover its insured’s flood damage losses, finding that disputes of fact remain on whether contractor’s invoices submitted to the insurer were fraudulent.
November 14, 2024
2nd Circuit Certifies Question To State Court In $6.6M No-Fault Payment Dispute

NEW YORK — The Second Circuit U.S. Court of Appeals certified to the New York Court of Appeals a question regarding an insurer’s ability to deny no-fault benefit payments to a health care provider upon finding improper payments for patient referrals in health care providers’ appeal of a district court’s ruling granting judgment for GEICO and awarding it $6,616,142.68 in damages in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit over purported fraudulent no-fault automobile insurance reimbursement.
November 13, 2024
U.S. High Court Declines Review Of FCA Suit Against Allstate Over Medicare Claims

WASHINGTON, D.C. — The U.S. Supreme Court on Nov. 12 denied a petition for a writ of certiorari filed by the owner of health care businesses and a related party seeking review of a Sixth Circuit U.S. Court of Appeals’ ruling affirming a district court’s dismissal based on the public disclosure bar of a qui tam suit alleging violations of the False Claims Act (FCA) regarding Allstate Insurance Co.’s alleged defrauding of Medicare related to claims for injuries incurred in auto accidents.
November 12, 2024
Group Outlines Dismissal Arguments In Another Reinsurer’s RICO Lawsuit

BROOKLYN, N.Y. — As it has done in a similar Racketeer Influenced and Corrupt Organizations (RICO) Act suit that a different reinsurer filed in New York federal court over purportedly fraudulent workers’ compensation claims and personal injury lawsuits, a group of defendants filed a pre-motion letter outlining plans to seek dismissal.
November 06, 2024
Insurer And Beneficiary Of $1.5M Policy Settle Suit Over Memory Misrepresentations

NEW ORLEANS — A Pennsylvania-based life insurer filed a notice advising a Louisiana federal court of a settlement in the insurer’s declaratory judgment suit against the beneficiary of a $1.5 million life insurance policy, seeking to void the policy due to multiple misrepresentations the decedent allegedly made in the policy application regarding memory and psychological issues.
November 06, 2024
Physician’s Suit Against GEICO Tossed For Failure To Allege ‘Protected Right’

BROOKLYN, N.Y. — A New York federal judge dismissed a suit filed by a physician and his medical practice against GEICO, alleging that it violated a New York civil rights law by interfering with the plaintiffs’ rights to provide lawful medical care, finding that GEICO’s underlying litigation against the physician and his practice alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations related to fraudulent billing does not constitute a claim for “unlawful interference with medical care.”
November 06, 2024
Jury Awards Cigna $7.25M In Suit Over Fraudulent Billing For Drug Testing

NEW HAVEN, Conn. — A Connecticut federal court jury has awarded Cigna Health and Life Insurance Co. $7,256,100.60 in damages in a suit alleging that Florida drug testing labs were unjustly enriched by submitting to Cigna claims for reimbursement for medically unnecessary urine drug testing, resulting in purported overpayments to the labs of more than $20 million.
November 05, 2024
DOJ Files Appearance In 11th Circuit Appeal Of FCA Unconstitutionality Ruling

ATLANTA — The U.S. Department of Justice (DOJ) on Nov. 4 in the 11th Circuit U.S. Court of Appeals filed lead counsel’s notice of appearance in an appeal by the U.S. government and a relator who filed a qui tam action on behalf of the government, seeking review of a district court’s ruling that dismissed for lack of standing under Article II of the U.S. Constitution the relator’s suit alleging that medical providers and Medicare Advantage (MA) insurers violated the federal False Claims Act (FCA).
November 04, 2024
Judgment Granted For State Farm In No-Fault Fraud Suit Involving Chiropractors

NEW YORK — A New York state justice granted summary judgment to State Farm in its suit seeking a judgment that it has no duty to pay for no-fault claims related to an auto accident where its insured driver and passengers purportedly sustained injuries and sought treatment from chiropractors and other medical providers, finding that the claimants’ failure to appear for an examination under oath (EUO) “voided the policy ab initio.”
November 04, 2024
New Jersey Panel Affirms Judgment For Insurer In Row Over $1M Auto Rental Coverage

TRENTON, N.J. — A New Jersey appellate court on Nov. 1 affirmed a lower court ruling granting summary judgment to an insurer and rescinding for material misrepresentation a $1 million nonowned auto liability policy issued to a business operating a summer camp, finding that the lower court correctly determined that there was no ambiguity in a question in the policy application where the insured answered in the negative regarding renting vehicles but actually rented vans that were not covered under the policy.
November 01, 2024
Insurer Seeks Policy Voidance, Declaration Of No Duty To Defend In Underlying Suit

CHEYENNE, Wyo. — A commercial insurer on Oct. 31 sued its insured trucking company and the company’s purported owners in a Wyoming federal court, seeking a declaration that the policy issued to the insured is void due to alleged material misrepresentations regarding ownership of the company and there is no duty to defend or indemnify the company in an underlying suit.
October 30, 2024
Judgment Granted For Liberty Mutual In No-Fault Dispute Over Misrepresentation

NEW YORK — A New York state justice granted summary judgment to Liberty Mutual in its declaratory judgment suit against medical providers and an insurance claimant who was injured in an auto accident and sought coverage pursuant to a policy issued to her mother, finding that Liberty Mutual is entitled to summary judgment due to the insured’s misrepresentation in the policy application that she was the only driver of the insured vehicle.