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Mealey's Insurance Fraud

  • April 03, 2026

    Insurer Seeks To Rescind Commercial Policies Over ‘Material Misrepresentations’

    BROOKLYN, N.Y. — A commercial general liability insurer filed a declaratory judgment suit in a New York federal court against its insured, seeking to rescind two commercial policies and asking the court to declare that it does not owe a duty to defend or indemnify the insured or anyone else involved in any underlying litigation related to the construction of sidewalk sheds due to the insured’s purported misrepresentations in insurance applications regarding the type of work it does.

  • April 02, 2026

    Illinois Panel Affirms Dismissal Of Auto Insurer’s Declaratory Judgment Suit

    CHICAGO — An Illinois appellate court affirmed a lower court’s dismissal of an insurer’s suit seeking a declaration that it did not owe coverage beyond the $25,000 policy limits to its insured, who was involved in an auto accident, ruling that the lower court was correct in finding that the insurer’s alleged bad faith liability regarding past conduct, which relates to a separate bad faith suit, “was more properly considered in the bad faith action.”

  • April 01, 2026

    Judgment Granted For Insurer In Suit Over Underlying Wrongful Death Litigation

    SAN JOSE, Calif. — A California federal judge granted an insurer’s motion for default judgment in its declaratory judgment suit against its insured related to underlying wrongful death litigation, finding that under the policy’s business description endorsement, the insurer has no duty to defend and indemnify in the underlying suit and that rescission is appropriate because of “the material misrepresentations” in the insured’s application for insurance.

  • April 01, 2026

    Insurer Seeks Default Judgment Against Boat Crew Member In Policy Rescission Suit

    KEY WEST, Fla. — One day after a Florida federal judge issued an order regarding the procedure to file for default final judgment, a general liability insurer on March 31 filed a motion for default final judgment against a boat crew member in the insurer’s suit seeking a policy rescission for alleged material misrepresentations in a policy renewal application and a declaration that it does not have a duty to defend or indemnify in an underlying negligence action related to a parasailing accident.

  • March 31, 2026

    Judge Tosses Insurance Mogul Bid To Compel Arbitration Related To Equity Purchase

    NEW YORK — A New York federal judge dismissed a suit filed by former insurance mogul Greg Lindberg seeking to compel arbitration to offset claims under an equity purchase agreement (EPA) between an investment company he once owned and sellers who sold their ownership interests in health care and pharmaceutical companies to his investment company, finding that the court lacks personal jurisdiction over any out-of-state defendants, that there is no valid claim for offset and that Lindberg lacks standing to assert claims on behalf of the investment company.

  • March 31, 2026

    Judge Cites 2nd Circuit Cases, Grants Injunction In Allstate No-Fault Fraud Suit

    BROOKLYN, N.Y. — Citing precedent from the Second Circuit U.S. Court of Appeals, a New York federal judge on March 30 granted Allstate’s motion for a preliminary injunction to stay no-fault arbitrations in state court filed by the same medical provider defendants Allstate is suing in federal court over their alleged participation in a no-fault fraud Racketeer Influenced and Corrupt Organizations (RICO) Act scheme, finding that “the risk of irreparable harm” absent a stay tips “the balance of hardships” in favor of Allstate because the outcome of the state court proceedings “could have a preclusive effect” on the federal court’s “ability to provide relief.”

  • March 31, 2026

    Judge Tosses Negligence Claims Against Adjuster Over ‘Inflated’ Hurricane Damage

    SAN JUAN, Puerto Rico — A Puerto Rico federal judge dismissed with prejudice a suit filed by an insurer against an insurance adjuster and his firm, which the Puerto Rico Highway and Transportation Authority hired to adjust claims related to damage from Hurricane Maria, alleging that the defendants negligently misrepresented property damages.  The judge said the case is time-barred by a one-year statute of limitations.

  • March 30, 2026

    U.S. High Court Won’t Review FCA Suit Against Quest Alleging Fraudulent Testing

    WASHINGTON, D.C.  — The U.S. Supreme Court on March 30 denied a qui tam relator’s petition for writ of certiorari asserting that the 11th Circuit U.S. Court of Appeals erred in affirming a lower court order dismissing as lacking in specificity her suit alleging that Quest Diagnostics Inc. violated the False Claims Act (FCA) and similar Georgia law by participating in a fraudulent scheme to order unnecessary laboratory testing that was then billed to government insurers.

  • March 27, 2026

    $60,605 In Attorney Fees Awarded In Policy Voidance Suit Over Murdered Spouse

    PHOENIX — An Arizona federal judge awarded $60,605 in attorney fees to a life insurer in a declaratory judgment suit seeking to void a $750,000 life insurance policy after the insurer paid death benefits to the beneficiary, the deceased insured’s husband, who was later convicted of her murder, finding that the husband had no just defense for failure to respond to the complaint and while the lodestar method to calculate attorney fees was appropriate, the attorney fee request was reduced by the hours of clerical work.

  • March 19, 2026

    Michigan Panel Reverses Dismissal Order In Insurer’s Car Accident Coverage Dispute

    DETROIT — A Michigan appellate court on March 18 reversed and remanded a lower court’s order dismissing a declaratory judgment suit by Progressive Michigan Insurance Co. alleging that it owed no coverage for an accident due to material misrepresentations about the garage locations of the insured vehicle, finding that the lower court abused its discretion when entering a dismissal order after entering a default judgment against certain defendants because the dismissal order prevented State Farm Mutual Automobile Insurance Co., the insurer of another vehicle involved in the accident, “from defending its interests as an interested party.”

  • March 18, 2026

    9th Circuit Reverses Dismissal Of Health System FCA Suit Against Drug Makers

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on March 17 reversed and remanded a lower court’s dismissal of a health system’s qui tam suit asserting violations of the False Claims Act (FCA) and related state laws by drug manufacturers participating in the Public Health Service Act’s Section 340B Drug Pricing Program, finding that because the health system brought an action pursuant to the FCA, the lack of a private right of action under Section 340B was not material and therefore the health system’s claims were not barred by Section 340B.

  • March 17, 2026

    Panel Dismisses Appeal Of Order Vacating Judgment In $150K Life Policy Dispute

    SEATTLE — A Washington state appellate court on March 16 dismissed an appeal by an estate administrator for her son’s estate seeking review of a lower court ruling vacating a default judgment against a life insurance company, finding that the administrator failed to establish standing in her initial complaint to seek death benefits under her son’s $150,000 life insurance policy.

  • March 16, 2026

    Summary Judgment Denied In FCA Suit Against Nursing Home Practitioner Providers

    EAST ST. LOUIS, Ill. — After denying a similar motion for summary judgment in 2023, an Illinois federal judge again denied a motion for summary judgment by companies that provide physician and nurse practitioner services for residents of long-term care (LTC) facilities in a False Claims Act (FCA) suit filed by the government against them, finding that disputes of fact remain regarding the falsity and scienter elements of the FCA.

  • March 13, 2026

    RICO, Conspiracy Claims Dismissed In Workers’ Comp Case Involving Reinsurer, MGA

    BROOKLYN, N.Y. — A New York federal judge dismissed without prejudice civil Racketeer Influenced and Corrupt Organizations Act (RICO) and RICO conspiracy claims brought by a reinsurer and a managing general agency (MGA) against medical providers and law firms in a workers’ compensation fraud suit, holding that alleged reimbursement and administrative injuries were too remote to establish proximate cause and that the reinsurer and MGA failed to plausibly plead an association-in-fact enterprise or agreement in their first amended complaint.

  • March 12, 2026

    Aetna Settles FCA Allegations Over Medicare Advantage Diagnosis Codes For $117.7M

    PHILADELPHIA — The U.S. Department of Justice on March 11 announced that Aetna Inc. has agreed to pay $117,700,000 to settle a relator’s qui tam suit filed in the U.S. District Court for the Eastern District of Pennsylvania alleging that Aetna and related entities violated the False Claims Act (FCA) by submitting inaccurate diagnosis codes for Aetna members enrolled in its Medicare Advantage plan to increase payments from Medicare.

  • March 12, 2026

    Suit Involving Cousin’s Purported Disability Fraud Is Dismissed As Untimely

    DALLAS — Without substantive explanation, a Texas federal judge overruled objections and accepted a report and recommendation to dismiss as untimely a lawsuit involving fraud and bad faith claims in which the pro se plaintiff challenged a roughly two-decade-old termination of long-term disability (LTD) benefits and alleged that a cousin fraudulently used her identity to file a successful disability claim.

  • March 11, 2026

    2nd Circuit Vacates Judgment For GEICO In $6.6M No-Fault Row With Acupuncturists

    NEW YORK —  The Second Circuit U.S. Court of Appeals on March 10 vacated and remanded a lower court ruling granting GEICO summary judgment on its declaratory judgment, common-law fraud and violation of the Racketeer Influenced and Corrupt Organizations Act (RICO) claims against acupuncture practices and related individuals (collectively, acupuncturists), resulting in a $6,616,142.68 damages award for GEICO, finding that the ruling was based on an inaccurate determination that a health care provider that “improperly buys patient referrals” cannot receive no-fault reimbursements.

  • March 11, 2026

    Judgment Granted For Travelers On Bad Faith Claim In Home Fire Coverage Dispute

    MACON, Ga. — A Georgia federal judge granted partial summary judgment to Travelers Personal Insurance Co. in a homeowner’s breach of contract and bad faith suit against the insurer for its purported failure to compensate the homeowner for a fire-related loss, finding that the insurer had reasonable grounds to deny the claim and, therefore, the bad faith claim fails.

  • March 10, 2026

    2nd Circuit Denies Mandamus Challenge To Recusal Denial In COVID Testing Fraud Row

    NEW YORK — The Second Circuit U.S. Court of Appeals issued a mandate denying a motion to stay and related petition for a writ of mandamus challenging lower court proceedings in which a judge denied recusal in qui tam suits alleging that the lab and related parties violated the False Claims Act (FCA) by submitting false claims to government insurers for reimbursement for COVID-19 testing services.

  • March 10, 2026

    PIP Claims Dismissed After Parties Stipulate To Dismissal In Coverage Dispute

    BROOKLYN, N.Y. — After the parties filed a statement indicating they have stipulated to dismissal, a New York federal judge dismissed with prejudice claims against an orthopedic practice and related parties in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit accusing them of filing fraudulent claims for payment for people allegedly involved in auto accidents and covered under GEICO no-fault or personal injury protection (PIP) policies.

  • March 10, 2026

    Judge Denies Insured’s Summary Judgment Motion In Medicaid Fraud Coverage Dispute

    WILMINGTON, Del. — A Delaware judge denied an insured’s motion for summary judgment as to the insurers’ affirmative defenses of reasonableness, fraud, collusion and bad faith in its lawsuit seeking professional liability coverage for an underlying Medicaid fraud investigation, holding that genuine disputes of material fact preclude summary judgment in this coverage dispute that was sparked by an investigation by the state of Texas that began almost 14 years ago.

  • March 09, 2026

    5th Circuit Affirms Attorney Fee Award Of Over $479,000 In ‘Frivolous’ FCA Suit

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on March 6 affirmed a lower court’s order adopting a report and recommendation to award attorney fees of $479,656.22 to a health care company and related entities in a relator’s qui tam suit against them asserting violations of the False Claims Act (FCA) regarding disputes over the Medicare Recovery Audit Contractor program, finding that the lower court did not abuse its discretion in finding attorney fees “justified” due to the relator’s claims being “frivolous.”

  • March 06, 2026

    Judge Won’t Dismiss Rescission Claims In Umbrella Policy Coverage Dispute

    ALLENTOWN, Pa. — A Pennsylvania federal judge denied dismissal of claims related to rescission, coverage and unjust enrichment in a declaratory judgment suit filed by a personal umbrella liability insurer seeking to rescind policies based upon the insured’s alleged material misrepresentations in policy applications regarding household composition and assets, finding that the insurer adequately alleged “the materiality” of information made in the applications.

  • March 05, 2026

    9th Circuit Reverses, Remands Judgment For Government In FCA Crop Insurance Case

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals reversed and remanded a lower court’s grant of summary judgment for the U.S. government in its suit alleging that a wheat farmer defrauded the government and violated the False Claims Act (FCA) by concealing harvested wheat and receiving crop insurance indemnity payments of more than $500,000, finding that issues of fact remain regarding whether the farmer acted with the required scienter under the FCA.

  • March 04, 2026

    Jury Says Rescission Justified In Life Insurer Suit Involving Missing Physician

    FORT MYERS, Fla. — After a jury returned a verdict finding that a life insurer was entitled to rescind its insured’s $1.4 million policy, a Florida federal judge on March 3 ordered the court clerk to enter judgment in favor of the insurer on the rescission issue and denied the insurer’s request for a declaratory judgment that the insured, a physician who has been missing at sea since Aug. 10, 2022, committed suicide.