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Mealey's Insurance Fraud

  • May 01, 2025

    Gilead Agrees To Pay $202M To Settle Alleged Speaker Kickback Claims In FCA Suit

    NEW YORK — The U.S. Attorney’s Office for the Southern District of New York announced that Gilead Sciences Inc. agreed to pay $202 million to settle a suit against it alleging that Gilead violated the False Claims Act (FCA) by paying remuneration to health care practitioners who spoke at Gilead speaker events to induce them to prescribe Gilead HIV drugs and causing false claims to be submitted to government insurers.

  • April 30, 2025

    Court Won’t Toss Suit Against Regeneron Over Alleged Fraud In Vision Drug Pricing

    BOSTON — A Massachusetts federal judge on April 29 denied dismissal of a qui tam suit against Regeneron Pharmaceuticals Inc. alleging violations of the federal False Claims Act (FCA) and similar state laws for purportedly fraudulently reporting the average sales price of a drug used to treat age-related vision impairment, finding that “the allegations sufficiently establish falsity under the FCA.”

  • April 30, 2025

    Stay Granted In $1B Insurance Fraud Case Pending Sentencing In Related Cases

    RALEIGH, N.C. — A North Carolina federal judge granted a consent motion to stay in a suit accusing Insurance magnate Greg Lindberg and his co-defendant asset management companies and other parties of Racketeer Influenced and Corrupt Organizations Act violations related to their purported participation in a $1 billion scheme to defraud now-insolvent insurers once owned by Lindberg.

  • April 30, 2025

    Dismissal Denied In RICO Suit Over Alleged ‘Worthless’ $25M Dermatology Practice

    NEW YORK — A New York federal judge denied dismissal of Racketeer Influenced and Corrupt Organizations Act claims against a couple and their dermatology practice in a suit by the companies that purchased the practice for approximately $25 million but alleged that it was “worthless” due to practices of fraudulent billing to insurers revealed in an audit, finding that the allegations suffice to “set forth acts of racketeering activity.”

  • April 29, 2025

    Magistrate: Relator Must Provide All Alleged False Claims In FCA Kickback Suit

    SAN DIEGO — A California federal magistrate judge granted Abbott Laboratories’ motion to compel discovery into all the alleged false claims it purportedly submitted to the government in a suit alleging Abbott violated the False Claims Act (FCA) and state false claim laws regarding Abbott’s purported kickback scheme to induce hospitals and physicians to use an Abbott cardiac medical device, finding that Abbott is “entitled to know the specific false claims” against it.

  • April 28, 2025

    New York Panel Reverses Judgment For Allstate In Fraud Misrepresentation Dispute

    ROCHESTER, N.Y.  — A New York state appellate panel on April 25 reversed a lower court order granting summary judgment to Allstate Vehicle and Property Insurance Co. in a breach of contract suit against it over its purported failure to cover its insured homeowners’ claim for fire-related damages, finding that the underwriting guidelines do not show that Allstate would have denied the insured’s application for insurance had it known of the alleged misrepresentations in the policy application.

  • April 25, 2025

    Default Judgment Entered Against Alleged Elder Abuser In LTC Insurance Fraud Suit

    MOBILE, Ala.  — An Alabama federal judge entered default judgment against an insured’s caregiver, who allegedly defrauded long-term care (LTC) insurer John Hancock Life Insurance Co., for failing to provide the more than $167,000 in services for which the caregiver received reimbursement, finding that because the caregiver failed to respond to the complaint or attend a court-ordered hearing, the complaint’s allegations, including that the caregiver was under investigation for elder abuse of the insured, are considered admitted.

  • April 24, 2025

    6th Circuit Affirms Dismissal Of FCA Suit Alleging Fraud In Emergency Room Boarding

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals affirmed a lower court’s dismissal of a suit filed by relator physicians against a hospital and its parent company alleging violations of the False Claims Act (FCA) and related Michigan law for purported fraud in submitting claims for payment to government insurers for emergency room patients who were boarded as inpatient patients but received allegedly deficient care in the ER before a bed was available for them, finding that the allegations fail to satisfy the particularity required for fraud pursuant to the Federal Rules of Civil Procedure.

  • April 22, 2025

    Motion To Compel Granted In Trademark Row Involving Health Care Fraudster

    BROOKLYN, N.Y. — A New York federal magistrate judge on April 21 granted a pharmaceutical company’s motion to compel in a Lanham Act trademark infringement case, seeking documents related to fee arrangement between defense counsel and his client, who pleaded guilty to conspiracy to commit health care fraud in a related case, finding in part that “the requested information is relevant” because plaintiffs in Lanham Act suits may recover a defendant’s profits.

  • April 22, 2025

    11th Circuit Reverses In Part Ruling In FCA Suit Over CPAP Billing To Tricare

    ATLANTA — The 11th Circuit U.S. Court of Appeals reversed in part and remanded a ruling by a lower court dismissing a qui tam complaint against a company and its subsidiary supplier of continuous positive air pressure (CPAP) sleep apnea devices, alleging violations of the federal False Claims Act (FCA) for purported fraudulent billing to government health insurers, including Tricare, finding that while the relator pleaded with specificity a claim for alleged fraud for upcoding, the “remaining claims fall well short of the mark.”

  • April 21, 2025

    Iowa Panel: Coverage For Derecho Damage Voided By Material Misrepresentations

    DES MOINES, Iowa — An Iowa appeals court panel held that a landscaping company’s insurance coverage for damage caused by an August 2020 derecho was voided by the insured’s material misrepresentations, affirming a lower court.

  • April 17, 2025

    9th Circuit Denies Petition For Panel Rehearing In FCA Medicare Fraud Row

    SAN JOSE, Calif. — In a one-page order without providing explanation, the Ninth Circuit U.S. Court of Appeals denied a petition for panel rehearing of its ruling affirming a lower court’s dismissal of a qui tam relator’s suit accusing pharmaceutical companies of violating the False Claims Act (FCA) by overcharging the federal government and states under Medicare and Medicaid.

  • April 16, 2025

    Insurer’s Motion To Disqualify Insured’s Counsel Granted In Hurricane Damage Row

    NEW ORLEANS — A Louisiana federal magistrate judge on April 15 granted an insurer’s motion to disqualify the insured’s counsel in a dispute over insurance coverage for hurricane damage and purported fraud over the estimates submitted to the insurer, finding in part that a conflict of interest exists due to the close business relationship between one of the insured’s attorneys and a restoration service used by the insured.

  • April 16, 2025

    Michigan Panel Reverses Dismissal Of Insurer In Row Over Auto Claim PIP Benefits

    DETROIT — A Michigan appellate court affirmed a lower court order denying summary disposition to an auto insurer in a personal injury protection (PIP) auto accident dispute but reversed the lower court’s ruling dismissing the PIP-assigned insurer, finding that disputes remain regarding an alleged material misrepresentation in the policy application and whether the son of the insured, who was injured in the accident, is an innocent third party.

  • April 15, 2025

    2nd Circuit Affirms Dismissal Of Qui Tam Suit Against Zocdoc Over Booking Fee

    NEW YORK — The Second Circuit U.S. Court of Appeals on April 14 affirmed a lower court ruling dismissing a qui tam suit alleging violations of the False Claims Act (FCA) against Zocdoc Inc., an internet-based company that enables individuals to search for medical providers, finding that the lower court correctly dismissed the suit and that the complaint failed to allege that Zocdoc acted with the scienter required under the FCA and the Anti-Kickback Statute (AKS) in assessing a booking fee for medical providers.

  • April 14, 2025

    Default Judgment Denied In Declaratory Judgment Suit Over Two $500K Life Policies

    COLUMBUS, Ohio — An Ohio federal judge on April 11 denied an insurer’s motion for default judgment against its insured in a declaratory judgment suit seeking to rescind two $500,000 life insurance policies for the insured’s purported misrepresentations regarding his health history, finding that the insurer failed to address why the insured was appropriately served in the motion for default judgment.

  • April 11, 2025

    3rd Circuit Affirms Dismissal Of FCA Suit Over ‘Hiding’ Antibiotics’ Side Effects

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals on April 10 affirmed a lower court’s dismissal of a qui tam relator’s suit against Bayer Corp., Johnson & Johnson, Merck & Co. and other pharmaceutical companies, alleging that “hiding” side effects of their antibiotics from the U.S. Food and Drug Administration “caused fraudulent claims to be submitted to Medicaid and Medicare,” finding that the relator failed to satisfy the essential elements of a False Claims Act (FCA) violation.

  • April 10, 2025

    Quash Motion Related To False Claims Investigation Denied In Licensure Dispute

    NEW HAVEN, Conn.  — A Connecticut federal magistrate judge denied a motion to quash and for a protective order filed by a dental practice and related parties seeking to stop the enforcement of a dental licensing statute prohibiting dental assistants from using radiology services without required training, finding that the motion to quash a subpoena for documents related to the Connecticut attorney general’s investigation into the practice’s alleged Connecticut False Claims Act violations for claims made to Medicaid “is premature.”

  • April 10, 2025

    Delaware Judge Dismisses 1 Insurer In Coverage Dispute Over Medicaid Fraud Claims

    WILMINGTON, Del. — Three days after an insured and one of its insurers filed a stipulation asking a Delaware court to dismiss with prejudice all claims against the insurer in a professional liability coverage dispute arising from a Medicaid fraud investigation, the judge ordered the case against the insurer dismissed.

  • April 09, 2025

    Panel Reverses, Remands In Row Over Estate’s Alleged Misrepresentations In PIP Row

    DETROIT — In a case on remand from the Michigan Supreme Court, a Michigan appellate court reversed a lower court’s ruling granting summary disposition to an insurer in a personal injury protection (PIP) dispute over whether alleged fraudulent answers to an interrogatory by an estate’s representative constituted material misrepresentations pursuant to Michigan law, finding that issues of fact remain regarding whether the representative knew the answers constituted false information.

  • April 09, 2025

    Magistrate Grants Wells Fargo’s Motion To Withhold Discovery In $300M Ponzi Suit

    MIAMI — A Florida federal magistrate judge granted in part Wells Fargo’s motion to withhold discovery in a putative class action alleging that Wells Fargo aided and abetted fraud in a “massive” Ponzi scheme purportedly orchestrated by owners of insurers, some of which are now in receivership, resulting in elderly investor victims losing more than $300 million after scheme operators sold them promissory notes secured by collateral in stranger-oriented life insurance policies (STOLIs).

  • April 08, 2025

    6th Circuit Affirms Dismissal Of Insurance Fraud Suit Absent Injury To Framer

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on April 7 affirmed a lower court’s ruling dismissing a suit filed by a framing subcontractor against a general contractor alleging that the general contractor committed insurance fraud in submitting claims to an insurer based on the subcontractor’s purported breach of contract, finding that the subcontractor failed to allege any injury caused by the purported insurance fraud.

  • April 08, 2025

    Judgment Granted For Insurer In Breach Of Contract Dispute Over $100K Settlement

    LEXINGTON, Ky. — A Kentucky federal judge adopted a magistrate judge’s report and recommendation to grant partial judgment on the pleadings to a homeowners insurer in its breach of contract suit against its insured seeking a return of a $100,000 insurance settlement issued to the insured prior to his insurance fraud conviction, finding that because the parties filed no objections, the court grant will grant the motion and hold that the insured breached the policy.

  • April 07, 2025

    Judgment Denied In Breach Of Contract, Bad Faith Suit Over $70K Life Policy

    ALBANY, Ga. — A Georgia federal judge granted in part and denied in part a motion for summary judgment filed by a life insurer in a breach of contract and bad faith suit against it by the beneficiary of a $70,000 life insurance policy, finding in part that a dispute of facts remains as to whether the decedent made misrepresentations in the policy application.

  • April 04, 2025

    Default Judgment Granted, $212K Policy Rescinded For Alleged Cannabis Use Fraud

    KANSAS CITY, Mo. — A Missouri federal judge granted a life insurer’s motion for default judgment after the insured failed to defend or plead in the insurer’s declaratory judgment suit seeking to rescind and void a $212,000 life insurance policy due to the insured’s alleged fraud regarding his misrepresentation in the policy application about not using marijuana in the last 24 months, which purportedly contradicts his medical records indicating a diagnosis of cannabis dependence.