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Mealey's Insurance Fraud

  • August 19, 2025

    Judge Denies CVS New Trial After Jury Verdict For Government In FCA Row

    NEW YORK — After a jury delivered a verdict in favor of the U.S. government in a federal False Claims Act (FCA) suit alleging that CVS Health Corp. (CVSHC) and its subsidiary Omnicare Inc. submitted fraudulent claims for payment to the government, a New York federal judge on Aug. 18 denied CVSHC’s and its subsidiary’s motions for a new trial or judgment as a matter of law, finding in part that CVSHC’s motion for judgment as a matter of law or, in the alternative, for a new trial “is procedurally improper.”

  • August 19, 2025

    Citing Settlement, Judge Dismisses Billing Fraud Suit Against Gynecology Office

    ORLANDO, Fla. — After being advised of an undisclosed settlement between the parties, a Florida federal judge dismissed with prejudice a suit filed by a former billing specialist for a Florida gynecology office asserting claims against the office for allegedly terminating her in violation of the retaliation provisions in the False Claims Act (FCA) and similar Florida law for refusing to submit and complaining about the fraudulent submission of claims for payment to Medicare for services purportedly performed by medical students without physician supervision.

  • August 19, 2025

    Summary Judgment Granted For Insurer On Roofing Company Claims In Wind Damage Row

    CEDAR RAPIDS, Iowa — An Iowa federal court judge granted summary judgment to a commercial insurer regarding a roofing company’s breach of contract and bad faith claims against it in a dispute over coverage for purported wind and hail storm damage, finding in part that the company’s claims fail because the company was assigned benefits of the insurance policy by the policy holder, the owner of apartment buildings, in violation of the policy’s anti-assignment clause.

  • August 15, 2025

    Judge Dismisses Condominium Coverage Dispute With Insurers, Notes Settlement

    NEW YORK —  After being advised “that the parties have reached a settlement,” a New York federal judge dismissed without prejudice a breach of contract suit filed against insurers over their alleged failure to cover a condominium’s purported hurricane-related losses.

  • August 14, 2025

    Texas Says Lilly Violated State Law To Induce Providers To Prescribe Its Drugs

    MARSHALL, Texas — Texas has sued Eli Lilly & Company Inc. in a state court, alleging that the pharmaceutical company violated the Texas Health Care Program Fraud Prevention Act (THFPA) through programs used to induce providers to prescribe its medications, including its GLP-1 medications Mounjaro and Zepbound.

  • August 06, 2025

    Reconsideration, Dismissal Denied In GEICO PIP Suit Against Chiropractic Center

    NEWARK, N.J. — A New Jersey federal judge on Aug. 5 denied GEICO’s motion for reconsideration of the court’s prior order compelling arbitration in a suit alleging that a chiropractic center and its chiropractor submitted to GEICO for payment fraudulent personal injury protection (PIP) claims, finding that GEICO did not meet the standard necessary for reconsideration.

  • August 06, 2025

    Judgment Granted For Insurer In Coverage Row Between Catering Business, Insurer

    TAMPA, Fla. — A Florida federal judge granted summary judgment to an insurer and denied summary judgment to its insured hospitality and catering business in a dispute over coverage for purported fire damage, finding that the insured cannot recover its claim for replacement cost value in part because it did not select replacement cost value under the policy.

  • August 05, 2025

    Magistrate Recommends Denying Bid For $10.88M In Insurer RICO Row With Former CEO

    FRESNO, Calif. — A California federal magistrate judge issued findings and recommendations advising the court to deny an insurer’s motion for default judgment and an award of $10,884,566.25 against its former CEO in the insurer’s fraud and Racketeering Influenced and Corrupt Organizations Act (RICO) suit against the former CEO, finding that while the insurer has provided a declaration related to the amounts of the alleged fraud, it failed to include documentary evidence to support that declaration.

  • August 05, 2025

    Parties Ordered To Submit Briefing Schedule In SEC Fraud Row With Insurance Mogul

    WINSTON-SALEM, N.C. — After reviewing the U.S. Securities and Exchange Commission’s status report, a North Carolina federal judge on Aug. 4 issued a docket-only order advising the parties to submit a briefing schedule within 10 business days of insurance mogul Greg Lindberg or a co-defendant being sentenced in related criminal proceedings to the SEC’s suit alleging that Lindberg, his advisory services company and its former executive defrauded clients of more than $75 million.

  • August 01, 2025

    Judge Won’t Reconsider Order Denying Providers’ Dismissal Bid In GEICO’s RICO Suit

    BROOKLYN, N.Y. — In a suit alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations against multiple diagnostic imaging providers and related parties, a New York federal judge denied the providers’ motion for reconsideration of the court’s prior order denying dismissal, finding that GEICO has established damages to show that the RICO claims are ripe.

  • July 30, 2025

    11th Circuit Reverses In Suit Seeking Policy Rescission Over Misrepresentations

    ATLANTA — The 11th Circuit U.S. Court of Appeals on July 29 reversed and remanded a district court order dismissing a general liability insurer’s suit seeking a policy rescission for purported material misrepresentations in a policy renewal application and a declaration that it does not have a duty to defend or indemnify an underlying negligence action related to a parasailing accident, finding that the lower court’s dismissal of the duty to defend claim was an abuse of discretion and that the district court should exercise jurisdiction regarding the rescission claim.

  • July 30, 2025

    Judge Won’t Toss FCA Suit, Certifies Order To 6th Circuit Regarding Article II

    CINCINNATI — An Ohio federal judge denied dismissal of a neurosurgeon’s a qui tam suit alleging that hospitals and related entities violated the federal False Claims Act (FCA) by participating in a purportedly illegal referral scheme and falsely certifying compliance with the Anti-Kickback Statute (AKS) and Stark Law, finding that the relator has standing to bring the case.

  • July 30, 2025

    Dismissal Denied In FCA Suit, Appeal On FCA Article II Constitutionality Certified

    CINCINNATI — An Ohio federal judge denied dismissal in a qui tam suit alleging that hospitals and related entities violated the federal False Claims Act (FCA) by submitting claims for payment to government insurers and alleging false compliance with federal laws due to the hospitals’ purported participation in an illegal referral scheme to increase the hospitals’ market share, finding that the relator adequately stated an FCA claim.

  • July 29, 2025

    6th Circuit Affirms Rulings For Administrator Of Tribe’s Health Care Plan

    CINCINNATI — Rejecting a variety of arguments advanced by a Native American tribe and its health plan, the Sixth Circuit U.S. Court of Appeals on July 28 affirmed rulings for the health plan’s third-party administrator (TPA) in a long-running dispute involving the Michigan Health Care False Claims Act (HCFCA) and Medicare-like rate (MLR) regulations.

  • July 29, 2025

    11th Circuit Affirms Judgment For Insurer, Cites Mayoral Affidavit Inconsistency

    ATLANTA — The 11th Circuit U.S. Court of Appeals on July 28 affirmed a lower court’s order granting summary judgment to an insurer in a dispute with its insured over purported misrepresentations regarding a claim for vandalism to the insured’s home, finding in part that because the insured’s mayoral candidate affidavit in Brunswick, Ga., regarding his residency there was inconsistent with his insurance application representing Atlanta as his primary residence, “no reasonable jury” could find that these conflicting statements show “anything other than a knowing misrepresentation about his residency.”

  • July 28, 2025

    11th Circuit Nixes LTD Insurer’s Unjust Enrichment Jury Victory Under Florida Law

    ATLANTA — Issuing a mixed ruling in a dispute where a federal jury sided with a long-term disability (LTD) insurer, the 11th Circuit U.S. Court of Appeals ordered the trial court to vacate a judgment of nearly $450,000 for the insurer on its unjust enrichment claim but upheld dismissal of a breach of contract counterclaim.

  • July 28, 2025

    On Remand From 9th Circuit, Judge Dismisses FCA Suit Against Drugmakers

    SAN FRANCISCO — On remand from the Ninth Circuit U.S. Court of Appeals and after the U.S. Supreme Court denied certiorari, a California federal judge dismissed without prejudice a qui tam suit accusing pharmaceutical companies of violating the False Claims Act (FCA) and related state laws by artificially inflating drug prices, finding that dismissal “is warranted” because the second amended complaint “lumps” the companies “together in an undifferentiated mass” regarding the alleged fraud.

  • July 25, 2025

    Federal Judge Tosses State Farm Fraud Referral ‘Scheme’ Unjust Enrichment Suit

    TAMPA, Fla. — A Florida federal judge on July 24 dismissed with prejudice State Farm’s suit asserting that a Florida medical provider and related entities and physicians violated the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) and were unjustly enriched by participating in a “scheme” of unlawful patient referral to surgery centers and submitting charges of more than $3.3 million for inclusion in settlement demands to State Farm.

  • July 23, 2025

    Judge Orders Disposition Of Proceeds In Insurance Magnate Money Laundering Case

    CHARLOTTE, N.C. — A North Carolina federal judge on July 22 approved a consent motion filed by a court-appointed special master to dispose of the proceeds from the sale of Irish software companies in a case in which insurance magnate Greg Lindberg pleaded guilty to money laundering conspiracy and conspiracy regarding his $2 billion scheme to defraud insurers and policyholders by funneling money through his extensive global network of insurance companies and was convicted on retrial in a related criminal proceeding.

  • July 23, 2025

    8th Circuit Affirms Ruling Barring Recovery For Fire Damage, Cites Arson Conviction

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on July 22 affirmed a district court ruling granting summary judgment to a bar’s insurer in a dispute over coverage for a fire that destroyed the bar, finding that conduct of one of the bar’s owners that resulted in an arson conviction can be attributed to the entities involved in managing the bar.

  • July 22, 2025

    11th Circuit Affirms $1.75M Judgment For Insured In Bad Faith Storm Damage Row

    ATLANTA — The 11th Circuit U.S. Court of Appeals on July 21 affirmed a $1.75 million judgment for an insured church in its bad faith and breach of contract dispute with its insurer over storm damage coverage, finding “no basis to revisit the evidentiary ruling” in which the lower court excluded evidence of alleged misrepresentation by the insured.

  • July 22, 2025

    Motion To Vacate Denied In GEICO’s PIP Suit Against Pain Management Clinic

    NEWARK, N.J. — A New Jersey federal judge denied GEICO’s motion to vacate an order compelling arbitration in a suit alleging that a pain management clinic and related parties submitted to GEICO for payment fraudulent personal injury protection (PIP) claims, finding that the motion is “deficient” as it is applicable only to final, not interlocutory, orders.

  • July 18, 2025

    Calling Complaint A ‘Mishmash’ Of ‘Schemes,’ Judge Partially Dismisses FCA Suit

    ROANOKE, Va. — A Virginia federal judge partially dismissed a qui tam suit alleging that Virginia behavioral health providers violated the federal False Claims Act (FCA) and similar state law by submitting fraudulent claims for payment to Medicaid, finding that “only one of the eight schemes is described in the second amended complaint with sufficient particularity” that is required to assert claims for fraud.

  • July 17, 2025

    Judge Tosses Suit Seeking Policy Rescission Regarding Coverage For Underlying Case

    HOUSTON — A Texas federal judge dismissed with prejudice an insurer’s suit seeking to rescind a commercial general liability policy issued to an apartment complex and to relieve the insurer of the obligation to indemnify and defend the complex in an underlying sexual assault suit, finding in part that the insurer failed to show its reliance on the purported misrepresentation in a policy renewal application.

  • July 16, 2025

    Judgment Entered For GEICO In Breach Of Contract Suit Over Settlement Agreement

    BROOKLYN, N.Y. —  In a breach of contract suit over purported failure to make payments according to a settlement agreement for an underlying no-fault fraud suit, a New York federal judge adopted a magistrate judge’s report and recommendation, granting GEICO’s motion for default judgment and finding a physician and his related businesses jointly and severally liable for $456,666.65 in damages.