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

Mealey's Insurance Fraud

June 07, 2024
Magistrate Orders Privilege Log Update In FCA Suit Over Medicare Advantage Fraud

TAMPA, Fla. — A Florida federal judge granted in part Medicare Advantage (MA) insurers’ motion to compel discovery in a relator’s qui tam suit alleging that medical providers and the insurers violated the False Claims Act (FCA) by conspiring together to increase risk adjustment scores of MA patients to obtain more federal funding than was owed, finding that the relator must update her privilege log but denying the insurers’ request for production regarding specified nonprivileged documents.
June 05, 2024
Allstate Sues Texas Pain Clinic, Doctors, Alleging Fraud And RICO Violations

HOUSTON — Allstate on June 4 filed a complaint in a Texas federal court against a Houston pain clinic, its owner and affiliated providers, alleging that they engaged in a “scheme” to defraud Allstate by billing for services that were unnecessary or not performed regarding Allstate’s insureds who were allegedly involved in auto accidents.
June 05, 2024
U.S. High Court Extends Response Deadline In Review Of 9th Circuit FCA Suit Ruling

WASHINGTON, D.C. — The U.S. Supreme Court on June 3 granted a 30-day extension for the qui tam plaintiff in a district court decision to respond to pharmaceutical companies’ petition seeking review of the Ninth Circuit U.S. Court of Appeals’ reversal of a district court’s dismissal of a suit accusing them violating the False Claims Act (FCA) by artificially inflating drug prices, arguing in part that the Ninth Circuit “created a circuit split by holding that a relator can avoid the public disclosure bar by ‘stitching together’ public disclosures.”
June 05, 2024
Dismissal Denied In GEICO $2.8M RICO Violation Suit Against North Carolina Doctors

CHARLOTTE, N.C. — A North Carolina federal judge denied dismissal of a suit alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations, fraud and unjust enrichment against North Carolina physicians and their medical practices for their purported $2.8 million fraudulent “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, finding, in part, that GEICO “plausibly” alleges “sufficient proximate cause.”
June 04, 2024
Judgment Denied For Insured Seeking Coverage From Allstate For ‘Suspicious’ Fire

BAY CITY, Mich. — A Michigan federal judge on June 3 denied partial summary judgment to a homeowner seeking appraisal and penalty interest in his suit against Allstate for failure to cover his claim for fire damage, finding that questions of material fact remain regarding whether the homeowner caused the “suspicious” fire, actually lived at the home and whether he concealed material facts when filing his claim with Allstate.
June 03, 2024
Judgment Denied For Allstate Absent Evidence Showing Prior Insurance Requirement

HOUSTON — A Texas federal judge on May 31 denied Allstate’s motion for summary judgment in a breach of contract and bad faith suit against it for failing to cover fire damage to its insured’s home, finding that issues of fact remain regarding whether the homeowner’s purported misrepresentations were material to Allstate’s assertion that it would not have issued the policy had it know of the homeowner’s lack of prior continuous coverage.
June 03, 2024
Relator In FCA Suit Alleging Medicare Advantage Fraud Seeks To Compel Discovery

TAMPA, Fla. — Medicare Advantage (MA) insurers and a relator in a qui tam suit brought on behalf of the federal government filed separate motions to compel discovery in a Florida federal court in a relator’s suit alleging that medical providers and the insurers violated the federal False Claims Act (FCA) by conspiring together to increase risk adjustment scores of MA patients to obtain more federal funding than was owed.
May 30, 2024
Magistrate Extends Discovery Deadline In State Farm’s No-Fault Fraud Suit

BROOKLYN, N.Y. — A New York federal magistrate judge on May 29 issued a docket-only order granting a motion filed by certain medical provider defendants to extend the discovery deadline in State Farm’s suit alleging that the medical providers submitted for reimbursement to State Farm fraudulent bills for ineligible or medically unnecessary services provided to auto accident victims eligible for State Farm no-fault benefits.
May 30, 2024
Michigan Panel Affirms Judgment For Man Seeking PIP Benefits After Vehicle Hit Him

DETROIT — In consolidated appeals, a Michigan appellate court affirmed a lower court’s judgment for a pedestrian after a jury determined that the pedestrian did not make material misrepresentations in his claim for personal injury protection (PIP) benefits after he was struck by a motor vehicle, finding that though counsel for the pedestrian engaged in “improper” conduct, because the incidents were “isolated,” “reversal is not required.”
May 29, 2024
Dialysis Provider’s Bid To Deny Attorney Fees Rejected In FCA Medicare Fraud Suit

BOSTON — A Massachusetts federal judge on May 28 granted in part a relator’s request for attorney fees in a suit alleging that a dialysis provider violated the False Claims Act (FCA) by fraudulently billing Medicare and Medicaid for unnecessary hepatitis B testing, finding that the total requested hours must be reduced by 40%, in part due to the difficulty for the court to review “improper billing practices.”
May 28, 2024
Panel Denies Insurer’s Bid To Disqualify Judge Who Said Stipulation ‘Stinks’

DAYTONA BEACH, Fla. — A Florida appellate court on May 24 denied an insurer’s petition to disqualify a lower court judge who made “disparaging” comments, including calling the stipulation between the insured and insurer “this little deal with the devil” in the insurer’s suit seeking to rescind its insured’s policy for purported misrepresentations, finding that the motion to disqualify in the lower court was not timely filed.
May 24, 2024
Judge Grants Judgment To Insurer In Dispute Where Bar Owner Made False Statements

MINNEAPOLIS — A Minnesota federal judge granted summary judgment to a business liability insurer that was sued for denying coverage for fire damage to its insured bar, finding that the bar’s owner, who pleaded guilty to arson for the fire that destroyed the bar, made false statements to defraud the insurer, and those actions were imputed to the bar.
May 21, 2024
3rd Circuit Won’t Review Class Certification In Suit Related To FCA Violations

PHILADELPHIA — The Third Circuit U.S. Court of Appeals denied a petition seeking interlocutory review of a district court’s order granting class certification in a suit alleging that Teva Pharmaceuticals Industries Ltd. and its executives violated the Securities Exchange Act by artificially raising the price of its stock and concealing information about the multiple sclerosis drug Copaxone, the subject of a False Claims Act (FCA) suit alleging that Teva engaged in a kickback scheme that increased the price of the drug, finding that “interlocutory review is not appropriate” at the class certification stage as to a merits review of the Securities Exchange Act.
May 16, 2024
Justice Says ‘Adjudged’ Constitutes Judgment In Insurance Coverage Dispute

NEW YORK — A New York state court justice denied medical providers’ motion to renew an order granting summary judgment for insurers in the insurers’ suit seeking a declaratory judgment that denial of claims for no-fault benefits was appropriate due to the insured’s purported material misrepresentations about her residence, finding that the motion for renewal was untimely as it was filed more than 30 days after entry of the final judgment that included the term “adjudged.”
May 15, 2024
Judge Overrules Abbott’s Objections To Discovery Order In FCA Suit Over Kickbacks

SAN DIEGO — A California federal judge on May 14 overruled Abbott Laboratories’ objections and affirmed a magistrate judge’s discovery order that denied Abbott’s motion to compel production of certain documents in a suit alleging violations of the False Claims Act (FCA) and state false claims laws regarding Abbott’s alleged kickback scheme to induce hospitals and physicians to use an Abbott cardiac medical device, finding that Abbott is not entitled to discover certain documents, which are considered privileged work product.
May 14, 2024
4 Entities Hurt By Vesttoo Collapse Sue China Construction Bank, Others For Fraud

NEW YORK — Asserting that they were some of the “biggest victims” of the alleged fraud underlying the collapse of Vesttoo Ltd., entities including Porch Group Inc. and Homeowners of America Insurance Co. (HOA) sued China Construction Bank Corp. (CCBC) and related parties in a New York federal court for fraud and negligent supervision and retention.
May 09, 2024
Magistrate Denies Motion For Indicative Relief In FCA Suit Alleging Overcharging

SAN FRANCISCO — A California federal magistrate judge denied a relator’s motion for an indicative ruling that pursuant to the Ninth Circuit U.S. Court of Appeals’ decision in United States ex rel. Silbersher v. Valeant Pharms. Int’l, Inc., a similar False Claims Act (FCA) suit brought by the same relator, the magistrate judge should grant the relator “relief” from the judgment on appeal to the Ninth Circuit after dismissing his claims that pharmaceutical companies overcharged the federal government and states under Medicare and Medicaid.
May 08, 2024
3rd Circuit Issues Mandate On Ruling Compelling Arbitration In GEICO’s Fraud Suit

PHILADELPHIA — The Third Circuit U.S. Court of Appeals on May 7 issued a mandate regarding its decision reversing and remanding district court rulings consolidated on appeal that claims under New Jersey’s Insurance Fraud Prevention Act (IFPA) cannot be arbitrated, finding that GEICO’s IFPA claims against multiple medical providers related to purported fraudulent claims for medical expenses reimbursement under no-fault laws “must be compelled to arbitration” pursuant to the Federal Arbitration Act (FAA).
May 07, 2024
2nd Circuit Issues Mandate Regarding Dismissal Of FCA Claims Affirmed On Appeal

NEW YORK — The Second Circuit U.S. Court of Appeals on May 6 issued a mandate regarding its ruling affirming a district court’s dismissal of a relator’s claim against a pharmaceutical company for violations of the federal False Claims Act (FCA) but vacating and remanding the lower court’s dismissal of state law claims, finding that the district court correctly found that the relator failed to show that the pharmaceutical distributor acted willfully pursuant to the FCA when allegedly giving customers business management tools in exchange for their agreements to purchase drugs.
May 07, 2024
State Farm Sues Spine Centers, Asserts Claims For $3.3M In Fraud Referral ‘Scheme’

TAMPA, Fla. — State Farm sued a Florida medical provider and related entities and physicians in a Florida federal court, asserting that the defendants violated the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) by participating in a “scheme,” where the provider unlawfully referred patients to surgery centers for a brokered fee and submitted or caused to be submitted charges of more than $3.3 million for inclusion in settlement demands to State Farm.
May 06, 2024
Motion To Compel Granted In Bad Faith Row With Insurer Making Fraud Counterclaim

SEATTLE — A Washington federal judge on May 3 granted in part an insurer’s motion to compel more complete responses to interrogatories in a bad faith suit filed against the insurer that counterclaimed for a declaration that it has no obligation to cover the insured due to his purported fraudulent misrepresentations about his auto accident injuries, finding that the insurer made reasonable requests, including requests for the insured’s social media postings.
May 03, 2024
7th Circuit Affirms FCA Liability Ruling, Finds Error In Medicare Damages

CHICAGO — The Seventh Circuit U.S. Court of Appeals on May 2 affirmed a district court’s judgment finding an owner and his three related health care companies liable for violating the False Claims Act (FCA) and Anti-Kickback Statute (AKS) regarding fraudulent Medicare billing but vacated in part the damages calculations, finding that the court erred in calculating damages related to Medicare claims that may or may not have been related to the kickbacks.
May 02, 2024
Chris Brown’s Recording Studio Insurer Appeals $2M Judgment To 6th Circuit

MEMPHIS, Tenn. — The insurer of a recording studio owned by musician Chris Brown on May 1 appealed a Tennessee federal judge’s final judgment requiring the insurer to pay $2,066,217.30 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.
May 01, 2024
Retaliation Claim Dismissed Against DME Supplier With $24.2M In FCA Liability

HUNTINGTON, W.Va. — A West Virginia federal judge on April 30 granted a durable medical equipment (DME) supplier’s motion to reconsider his ruling denying summary judgment for a retaliatory discharge claim regarding a former employee’s reporting to supervisors alleged overbilling by the supplier that settled a separate False Claims Act (FCA) suit for $24.2 million, finding that the previous order should be revised “to prevent manifest injustice.”
May 01, 2024
9th Circuit Denies Homeowner’s Rehearing Bid In Fire Loss Coverage Dispute

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on April 30 denied a homeowner’s request for rehearing and rehearing en banc of its decision affirming a district court’s grants of summary judgment for insurers in two coverage disputes consolidated on appeal regarding whether the homeowner misrepresented in the insurance application that she used her property for commercial purposes or that she had prior losses.