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

Mealey's Insurance Fraud

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.
October 29, 2024
Quash Motion Denied In RICO Suit Over Fraudulent No-Fault Claims Totaling Millions

BROOKLYN, N.Y. — A New York federal magistrate judge on Oct. 28 denied a nonparty’s motion to quash a subpoena seeking production of documents related to his bank accounts in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit alleging that the defendant medical providers and physicians participated in a multimillion-dollar fraudulent scheme to bill the plaintiff insurer for medically unnecessary services, finding “that the request is not overly broad but appropriately tailored to information relating to people and entities allegedly involved in the scheme.”
October 29, 2024
Connecticut Judge Awards $39.2M To State In Fraud, Kickback Suit Against Pharmacy

HARTFORD, Conn. — A Connecticut state court judge awarded the state of Connecticut $39,254,239.20 in damages and penalties in a suit against Florida-based Assured Rx LLC and its former owner and operator asserting claims pursuant to the Connecticut False Claims Act related to the defendants’ alleged kickback scheme that involved paying customers to obtain prescriptions for compound drugs made and distributed by Assured, finding that Assured knowingly caused the submission of false claims for reimbursement to a state insurance plan.
October 28, 2024
Motion To Quash Denied In $3M STOLI Policy Row Involving Insurer And Intermediary

CINCINNATI — A federal magistrate judge on Oct. 25 denied a retired life insurance company employee’s motion to quash a subpoena in a special action filed in Ohio federal court related to litigation in a Delaware federal court where a life insurer sued a securities intermediary seeking a declaratory judgment that a policy owned by the securities intermediary is void ab initio as a stranger originated life insurance (STOLI) policy, finding that the insurer and employee failed to show that deposing the employee “would impose an undue burden or is not proportional to the needs of the case.”
October 25, 2024
11th Circuit Affirms $690K Judgment For GEICO In No-Fault Suit Over Improper Billing

ATLANTA — The 11th Circuit U.S. Court of Appeals on Oct. 24 affirmed a district court’s $690,251.44 judgment for GEICO in its suit against a health care clinic and related parties for allegedly submitting fraudulent no-fault insurance charges, finding that the appellants failed to show that the District Court committed “reversable error” in its determination that the appellants “submitted requests for reimbursement for non-reimbursable services.”
October 22, 2024
Lincoln National Seeks To Void $500K Life Policy For Health Misrepresentations

ATLANTA — The Lincoln National Life Insurance Co. on Oct. 21 filed a complaint against the personal representative for the estate of its insured, seeking a declaratory judgment that the decedent’s $500,000 life insurance policy is void ab initio due to the insured’s purported material misrepresentation regarding his cancer diagnosis.
October 22, 2024
Illinois Panel Partly Reverses Ruling In Coverage Dispute Over Dog Attack

SPRINGFIELD, Ill. — An Illinois appeals panel reversed a lower court’s grant of summary judgment in favor of defendants in a homeowners insurer’s declaratory judgment lawsuit disputing coverage for bodily injury caused by a dog attack, finding that there is a genuine issue of material fact regarding whether the insured misrepresented her ownership of a pit bull.
October 17, 2024
11th Circuit Affirms Judgment For Repair Shop In GEICO Repair Act Fraud Suit

ATLANTA — After the Florida Supreme Court answered in the negative questions regarding whether violations under the Florida Motor Vehicle Repair Act, including failure to provide a written estimate, preclude a repair shop from receiving payment from an insurance company, the 11th Circuit U.S. Court of Appeals affirmed a district court’s judgment dismissing a claim and granting summary judgment to the repair shop on the remaining claims, partially due to GEICO’s concession that the complaint fails upon a judicial determination that “alleged Repair Act violations do not void the repair invoice.”
October 15, 2024
U.S. High Court Declines To Review 7th Circuit’s Ruling Affirming FCA Liability

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 15 denied a petition for a writ of certiorari filed by a business owner and his three health care companies seeking review of a Seventh Circuit U.S. Court of Appeals ruling affirming a district court’s judgment finding the owner and his companies liable for violating the False Claims Act (FCA) and Anti-Kickback Statute (AKS) for fraudulent Medicare billing.
October 15, 2024
Judgment Entered In Favor Of Insured In Coverage Dispute Over Fireworks Explosion

BISMARCK, N.D.— A federal court in North Dakota entered a judgment in favor of an insured in a homeowners insurer’s declaratory judgment lawsuit disputing coverage for underlying property damage and personal injuries caused by a fireworks explosion after finding that the policy’s misrepresentation provision does not bar coverage because the insured did not willfully conceal or misrepresent any material facts regarding his use and storage of commercial fireworks at his Bismark property.
October 14, 2024
Judgment Granted For Vehicle Insurer In Fraud Suit Over Driver Misrepresentation

RIVERSIDE, Calif. — A California federal judge granted summary judgment to a motor carrier insurer in its suit seeking a determination that it is entitled to rescind its insured’s policy due to the insured’s material misrepresentation in his policy application where he omitted listing as a driver his employee who was killed in a motor vehicle accident while driving one of the insured’s vehicles.
October 14, 2024
Intervention Denied In Coverage Row Over Yacht Deemed ‘Remnant Of Its Former Self’

SAN JUAN, Puerto Rico — A Puerto Rico federal judge denied intervention in a declaratory judgment suit against an insured by parties whose boats were purportedly harmed by fire that spread from a nearby yacht the judge called a “charred remnant of its former self,” finding that the proposed intervenors failed to establish that their interests “are not adequately represented by the defendant.”
October 10, 2024
Standing, Adequacy Of RICO Allegations Disputed In Reinsurer’s Lawsuit

BROOKLYN, N.Y. — A New York federal judge has dismissed a Racketeer Influenced and Corrupt Organizations (RICO) Act lawsuit without prejudice against more than a dozen defendants that a reinsurer alleged took part in purportedly fraudulent workers’ compensation claims and personal injury lawsuits.
October 10, 2024
Claims Objection Bar Date Extension Granted In Liquidation Of Vesttoo

WILMINGTON, Del. — A Delaware federal bankruptcy judge has granted a motion to extend the claims objection bar date by 180 days to April 7 in the Chapter 11 liquidation of Vesttoo Ltd. and its dozens of affiliates.
October 10, 2024
Bar Seeks 8th Circuit Reversal In Fire Damage Coverage Row, Cites Scope Of Actions

MINNEAPOLIS — A corporation operating a bar and the former spouse of the bar’s prior owner, who pleaded guilty to arson for the fire that destroyed the bar, filed a reply brief in the Eighth Circuit U.S. Court of Appeals urging the court to reverse a district court’s grant of summary judgment to the bar’s insurer upon finding that the arsonist’s false statements to defraud the insurer were imputed to the bar.
October 09, 2024
Judge Rules On Report And Recommendation In FCA Nursing Home Staffing Dispute

PHILADELPHIA — A Pennsylvania federal judge adopted in part a special master’s report and recommendation in a relator’s qui tam suit against Kindred Healthcare Inc. and its subsidiaries, alleging that they misrepresented their compliance with staffing requirements to receive larger reimbursements from Medicare and Medicaid, overruling the relator’s objections to the recommendation that discovery be limited to medical records related to providing services regarding activities of daily living.
October 08, 2024
Complaint Unsealed In FCA Suit Accusing Assisted Living Provider Of Medicaid Fraud

NEW YORK — A New York federal judge unsealed a qui tam complaint filed by a relator asserting that a New York state assisted living provider violated the federal False Claims Act (FCA) and similar New York state law and defrauded Medicaid by falsely inflating residents’ level of care scores to increase per diem Medicaid capitated billing rates.
October 07, 2024
Judge Denies Motion To Strike As ‘Highly Inappropriate’ In GEICO’s PIP Fraud Suit

FORT LAUDERDALE, Fla. — A Florida federal judge denied a physical therapy provider’s motion to strike in a suit filed by GEICO against it and other entities alleging that the defendants submitted more than $2.8 million in fraudulent charges for unnecessary services for personal injury protection (PIP) insurance charges, finding that the defendants’ request to strike pages of GEICO’s reply brief supporting its partial summary judgment motion “is a highly inappropriate request” without supporting legal authority.
October 07, 2024
U.S. Supreme Court Denies Cert In FCA, Anti-Kickback Violations Row

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied certiorari of a qui tam relator’s petition seeking review of a Second Circuit U.S. Court of Appeals ruling affirming a district court’s dismissal of federal False Claims Act (FCA) suit alleging violations of the Anti-Kickback Statute (AKS), where the relator argued for review to resolve the split between circuit courts regarding whether knowledge that a party’s conduct violates the law is required to show willfulness pursuant to the AKS.
October 07, 2024
U.S. Supreme Court Denies Certiorari In FCA Public Disclosure Bar Dispute

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied a petition for certiorari filed by pharmaceutical companies seeking review of the Ninth Circuit U.S. Court of Appeals’ ruling that the public disclosure bar was not triggered in a case where it reversed a district court’s dismissal of a suit accusing the companies of violating the False Claims Act (FCA) by artificially inflating drug prices.
October 07, 2024
U.S. High Court Won’t Review Ruling Upholding FCA Settlement Agreement Orders

WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied a petition for writ of certiorari filed in the U.S. Supreme Court by the owner of medical clinics seeking review of the Sixth Circuit U.S. Court of Appeals’ ruling upholding a district court’s orders enforcing a settlement agreement and compelling the owner to seek U.S. government consent to dismiss claims for federal False Claims Act (FCA) violations in a separate qui tam suit.
October 07, 2024
Judge: Insurer Will ‘Quibble’ With Analysis In $2M Life Policy Ruling For Spouse

SEATTLE — A Washington state federal judge denied a life insurer’s motion for summary judgment but granted a cross-motion for summary judgment by a decedent’s spouse and beneficiary of the decedent’s $2 million life insurance policy, finding that though the insurer “will quibble with” the interpretation of the policy application where the insured answered “no” to questions about visiting his physician but did visit his dentist, “there is no dispute that ‘physician’ is at least ‘fairly susceptible’ to two interpretations” in the insurer’s suit seeking to rescind the policy due to the insured’s purported material misrepresentations.
October 03, 2024
Discovery Ruling Issued In Insurance Fraud Suit Seeking Relief Under ERISA, UCL

LOS ANGELES — A California federal magistrate judge substantially granted a motion to compel discovery filed by a cheese manufacturing company in its suit against surgery centers for alleged fraudulent billing for health care plan benefits related to unnecessary or unperformed medical services, restitution under the Employee Retirement Income Security Act (ERISA) and violations of California’s unfair competition law (UCL), finding in part that the defendants’ privacy concerns are outweighed by the need for the discovery information that will be reviewed under a stipulated protection order that will address those concerns.
October 03, 2024
Lab Testing Company Settles FCA Unnecessary Testing Allegations For $27M

WASHINGTON, D.C. — The U.S. Department of Justice (DOJ) on Oct. 2 announced that Precision Toxicology LLC, a urine drug testing toxicology laboratory, agreed to pay $27 million to resolve allegations that it violated the False Claims Act (FCA) and similar state false claims statutes for its role in billing Medicare, Medicaid and other federal insurers for medically unnecessary urine drug tests and for providing remuneration to physicians who agreed to refer laboratory testing to Precision.
October 03, 2024
Insurer Calls Motion ‘Self-Serving’ In $2M Life Policies Misrepresentation Row

MACON, Ga. — Pacific Life Insurance Co. filed a response brief in a Georgia federal court asking the court to deny a motion in limine filed by the beneficiary of two $1 million life insurance policies who is seeking to exclude evidence that the insurer would have issued the policies at a different premium had it known of the policy application misrepresentations.