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Mealey's Insurance Fraud

  • July 10, 2025

    1st Circuit Issues Errata After Affirming Dismissal Of FCA Suit Against Clinics

    BOSTON — The First Circuit U.S. Court of Appeals on July 9 issued an errata to correct an error in its prior opinion affirming a lower court’s rulings dismissing and denying a motion to amend a relator’s qui tam suit against dialysis clinics alleging violations of the federal False Claims Act (FCA) related to a purported fraudulent kickback scheme.

  • July 10, 2025

    Summary Judgment Partially Granted For Insurer In Dispute Over Fire Coverage

    SEATTLE — A Washington federal judge partially granted summary judgment for an insurer in a coverage dispute related to underlying litigation regarding an apartment complex fire, finding that the insured made material omissions in failing to keep the insurer updated on the insured’s status as a party in the underlying litigation.

  • July 08, 2025

    Judge Imposes Penalties Of $542M Against CVS Subsidiary In FCA Row With Government

    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 July 7 imposed penalties of $542 million on Omnicare, finding that the penalties requested by the government do not exceed “the Eighth Amendment's guardrails.”

  • July 08, 2025

    Magistrate Won’t Dismiss Vermont False Claims Act Suit Over Wrongful Termination

    BURLINGTON, Vt.  — A Vermont federal magistrate judge denied dismissal of a suit alleging violations of the Vermont False Claims Act (VFCA) for a company’s purported wrongful termination of a physician/chief medical officer of operations for the Vermont Department of Corrections, finding that the physician does not need to “plead the submission of a fraudulent claim” to show that he engaged in protected activity under the act.

  • July 07, 2025

    11th Circuit ‘Largely’ Affirms Dismissal Of FCA Suit Against Ga. Family Practices

    ATLANTA — The 11th Circuit U.S. Court of Appeals “largely” affirmed a lower court’s dismissal of a qui tam suit alleging violations of the federal False Claims Act (FCA) and similar Georgia state law regarding a family practitioner and his practices allegedly submitting false claims to Medicare and Medicaid through various “schemes,” finding that the allegations sufficed for the kickback and self-referral schemes but that the lower court correctly dismissed the other claims.

  • July 03, 2025

    Report Advising Sanctions For Lost Text Messages Accepted In Insurance Coverage Row

    MINNEAPOLIS — A Minnesota federal judge accepted a magistrate judge’s report and recommendation advising granting sanctions only as to an adverse inference instruction related to the purported destruction of text messages by an insured, a Minneapolis event center, in the insurer’s suit seeking a declaration that it does not need to pay an appraisal award of $986,436 related to business income loss the insurer says was based upon “concealed and misrepresented material facts and circumstances willfully and with intent to defraud.”

  • July 02, 2025

    DOJ, HHS Announce FCA Working Group Partnership ‘To Combat’ Health Care Fraud

    WASHINGTON, D.C. — The U.S. Department of Justice (DOJ) on July 2 issued a press release announcing a partnership with the U.S. Department of Health and Human Services (HHS) to form a False Claims Act (FCA) Working Group “to combat” health care fraud.

  • July 02, 2025

    Yacht Insurers Sue Owners, Seeking Finding Of No Coverage For Flooding Incident

    KEY WEST, Fla. — Insurers of a yacht sued the vessel’s owners and the bank listed as the loss payee in a Florida federal court, seeking a declaration that there is no coverage under the policy for a flood-related loss due in part to the insureds’ purported misrepresentations regarding their claim in the policy renewal questionnaire that they had complied with the fire extinguishing equipment warranty.

  • July 02, 2025

    New York Panel Affirms Judgment Rescinding Insurance Policy In Coverage Row

    NEW YORK — A New York state appellate court affirmed a lower court order granting an insurer’s motion for summary judgment and rescinding an insurance policy for purported misrepresentations in the policy application and finding that the insurer has no duty to defend or indemnify in an underlying personal injury suit, finding that the additional insured failed to show that the insurer’s motion for summary judgment should have been denied pursuant to a waiver defense.

  • July 01, 2025

    Judgment Entered For Insurer In Driving Record ‘Misrepresentation’ Dispute

    RALEIGH, N.C. — A North Carolina federal judge on June 30 granted a boat insurer’s motion for judgment on the pleadings, construing it as a summary judgment motion in a coverage dispute, finding that the insurer is entitled to summary judgment due to a policy exclusion and is not bound by the terms of the policy due to the insured’s “material misrepresentation” regarding his driving record.

  • July 01, 2025

    1st Circuit Affirms Dismissal Of FCA Suit Against Clinics Alleging Kickbacks

    BOSTON — The First Circuit U.S. Court of Appeals affirmed a lower court’s rulings dismissing and denying a motion to amend a relator’s qui tam suit against dialysis clinics alleging violations of the federal False Claims Act (FCA) related to a purported fraudulent kickback scheme, finding that the relator failed to meet the heightened pleading standards required by the Federal Rules of Civil Procedure and that the lower court did not abuse its discretion in denying leave to amend.

  • June 26, 2025

    Texas Federal Judge Partly Grants Judgment In State Farm’s RICO Insurance Fraud Row

    SAN ANTONIO — A Texas federal judge partially granted a physician and his practice’s summary judgment motion in State Farm’s Racketeer Influenced and Corrupt Organizations Act (RICO) fraud suit alleging that the physician submitted fraudulent medical bills inflating the severity of patients’ injuries for medically unnecessary injections, finding that summary judgment is warranted for the RICO claim allegation based on “fabricated treatment or patients.”

  • June 23, 2025

    N.J. Panel Vacates Order Denying Allstate Motion To Disqualify Law Firm In PIP Row

    TRENTON, N.J.  — A New Jersey appellate court vacated a lower court order denying Allstate’s motion to disqualify a law firm representing approximately 35 of the 42 defendants in a suit over an alleged personal injury protection (PIP) fraud “scheme,” finding that the lower court erred in its determination that there was no risk for conflict among the defendants represented by the firm.

  • June 20, 2025

    Federal Judge Tosses Reinsurers RICO ‘Fake Accident’ Suit Against Law Firm, Agent

    BROOKLYN, N.Y. — A New York federal judge on June 19 dismissed without prejudice a Racketeer Influenced and Corrupt Organizations Act (RICO) suit against a law firm and its agent accused of a “scheme” to defraud a reinsurer and a related party by staging construction-related workers’ compensation accidents, finding that the claims fail for lack of pleading “direct injuries.”

  • June 20, 2025

    Parties File Stipulation Of Dismissal In FCA Suit Over ‘Substandard’ Care

    PHILADELPHIA — Nursing homes and related entities sued by the U.S. government over alleged violations of the False Claims Act (FCA) related to purportedly providing “grossly substandard nursing home services to Medicare and Medicaid beneficiaries” filed, together with the government, a joint stipulation of dismissal with prejudice in Pennsylvania federal court.

  • June 19, 2025

    Judge Tosses FCA Suit, Denies Motion To Amend In Case Alleging Medicare Fraud

    WASHINGTON, D.C.  — A District of Columbia federal judge denied relators’ motion to amend and dismissed their qui tam suit alleging that a hospital and related parties violated the federal False Claims Act (FCA) by submitting claims to Medicare and Medicaid that allegedly falsely attested compliance with participation in those programs, finding that the relators failed to state a claim for relief and that amendment would be futile.

  • June 18, 2025

    Lower Court Properly Found Auto Insurer Acted Reasonably In Handling Claim

    SEATTLE — A district court did not err in finding that an auto insurer acted reasonably in handling an insured’s claim for lost wages and damages following the insured’s involvement in an auto accident and also did not err in finding that the insurer’s filing of a counterclaim for fraud was not an act of insurance bad faith, the Ninth Circuit U.S. Court of Appeals said in affirming the district court’s ruling.

  • June 17, 2025

    Split West Virginia Court Reverses Ruling On Insurer’s Setoff In Fire Coverage Row

    CHARLESTON, W. Va. — In a dispute over fire damage coverage regarding alleged arson and fraud, a split West Virginia appellate court reversed and remanded a lower court’s ruling that denied the homeowners insurer with a setoff for contractual damages by the amount paid by the insurer to satisfy the homeowners’ mortgage, finding that the insurer preserved its right for a setoff.

  • June 16, 2025

    Florida Panel Reverses Judgment For Homeowner In Row Over Fire Damage Coverage

    DAYTONA BEACH, Fla. — A Florida appellate court on June 13 reversed and remanded a lower court’s ruling granting summary judgment to a homeowner in her dispute with the Florida Insurance Guaranty Association (FIGA) over coverage for fire damage, finding that material issues of fact remain regarding whether the homeowner’s husband, another insured under the policy, violated a policy provision regarding fraud.

  • June 13, 2025

    Calif. Panel Affirms $200K Judgment Against Life Policy Beneficiary In Fraud Row

    LOS ANGELES — A California appellate court on June 12 affirmed a lower court judgment awarding a decedent’s son $35,000 for elder abuse and the decedent’s estate $165,000 for unjust enrichment against the woman the son sued alleging fraud in her making herself a beneficiary under the decedent’s $200,000 life insurance policy, finding no need for the jury to consider whether the beneficiary change was related to fraud because the damages finding in a jury question addressed the fraud presumption.

  • June 12, 2025

    Judge Adopts Recommendation To Award GEICO Attorney Fees In No-Fault Fraud Dispute

    TAMPA, Fla. — A Florida federal judge adopted in full a magistrate judge’s report and recommendation advising that the court grant GEICO’s motion for attorney fees in a case where the court previously entered a $690,251.44 judgment for the insurer in its suit against a health care clinic and related parties for allegedly submitting fraudulent no-fault insurance charges.

  • June 11, 2025

    Neb. Panel Reverses Judgment For Insurer In $75K Life Policy Misrepresentation Row

    LINCOLN, Neb. — The Nebraska Court of Appeals on June 10 reversed and remanded a lower court order granting summary judgment to a life insurer in a dispute with the beneficiary of a $75,000 life insurance policy regarding alleged material misrepresentations in the policy application, finding that there is a fact dispute about an insurance agent’s knowledge of the insured’s back surgery that could be imputed to the insurer.

  • June 10, 2025

    Judge Denies CVS’s Directed Verdict Motion In FCA Dispute With Government

    NEW YORK — After a jury delivered a verdict against CVS Health Corp. (CVSHC) but said CVSHC’s conduct did not result in damages to the government in a federal False Claims Act (FCA) suit alleging submission of fraudulent claims for payment to the government, a New York federal judge denied CVSHC’s motion for a directed verdict, finding that the government’s “evidence demonstrates more than the type of conduct or lack of conduct that has been held insufficient in other False Claims Act cases.”

  • June 09, 2025

    Insurer’s Motion To Compel Granted In Row Over Coverage For Underlying FCA Suit

    BUFFALO, N.Y. —  A New York federal magistrate judge granted an insurer’s motion to compel discovery in a dispute over whether its insureds are entitled to coverage in an underlying qui tam suit alleging violations of the federal False Claims Act (FCA) regarding Medicare fraud, finding in part that the policyholders’ argument that the motion is barred by delay lacks “merit.”

  • June 06, 2025

    Motion To Compel Partially Granted In Coverage Dispute With Debris Removal Company

    NEW YORK  — Agreeing with an insured debris removal company and its principal that an insurer’s discovery request covering a 10-year period is “overly broad,” a New York federal judge partially granted the motion to compel discovery in an insurer’s suit seeking to rescind two insurance policies for purported fraudulent misrepresentations in insurance applications, granting discovery limited to one year before the initial policy application and until the end of the last policy renewal period.