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Mealey's Insurance Fraud

  • 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.

  • March 04, 2026

    Settlement Conference Set After Judgment Granted In Insurance Application Dispute

    LAS VEGAS —  A Nevada federal magistrate judge ordered the parties to appear for a settlement conference after a federal judge granted in part and denied in part cross-motions for summary judgment in insureds’ suit seeking coverage for expenses in defending another suit regarding fraud-based claims.

  • March 03, 2026

    Judge Won’t Dismiss FCA Suit Alleging Fraud, Kickback ‘Scheme’ Against Hospitals

    CHATTANOOGA, Tenn. — A Tennessee federal judge denied dismissal of qui tam relators’ suit alleging that Tennessee hospitals participated in a “scheme” in violation of the False Claims Act (FCA) by paying kickbacks to physicians who referred patients to the hospitals and submitted alleged false claims for reimbursement to government insurers, finding that the U.S. government’s complaint in intervention suffices to provide “examples of fraudulent conduct.”

  • February 27, 2026

    Judge: Insurer Was Entitled To Rescind Commercial Policy In Dispute With Insured

    NEW YORK — A New York federal judge on Feb. 26 granted summary judgment for an insurer in a suit seeking rescission of a commercial policy issued to its insured hotel owner, finding that the insurer showed that it was “entitled to rescind the policy” because the facts show that the insured made a misrepresentation in the policy application.

  • February 25, 2026

    N.C. High Court Won’t Stay $526M Damages Award Against Pro Se Insurance Mogul

    RALEIGH, N.C. — Without providing an explanation, the North Carolina Supreme Court on Feb. 24 issued orders dismissing a petition for a writ of supersedeas and motion for a temporary stay filed by former insurance mogul Greg Lindberg, now proceeding pro se, seeking a stay of trial court orders, including an order requiring him and his companies to pay $526 million in damages regarding conversion of assets in insurers’ breach of contract suit against him.

  • February 24, 2026

    Magistrate Won’t Dismiss Counterclaims, Grants Stay In Liability Coverage Dispute

    JOHNSTOWN, Pa. — A Pennsylvania federal magistrate judge on Feb. 23 dismissed a professional liability insurer’s motion to dismiss bad faith and fiduciary duty counterclaims but granted an alternate motion to bifurcate and stay the counterclaims in the insurer’s declaratory judgment suit disputing coverage for an underlying action arising from alleged sexual abuse by a pediatrician.

  • February 23, 2026

    U.S. High Court Denies Cert For FCA Fraud Suit By Whistleblower Physician

    WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 23 denied a petition for a writ of certiorari filed by a whistleblower physician seeking review of the affirmance of a district court order denying his motion to reopen a federal and state false claims act violations suit alleging fraudulent Medicare and Medicaid billing by a health system.

  • February 23, 2026

    Pa. False Claims Act Bill Stalls In Senate HHS Committee

    HARRISBURG, Pa. — As of Feb. 23, Pennsylvania House Bill 1697, the Taxpayer Prevention Against Fraud Act sponsored by Rep. Frank Burns (D-Cambria Co.), who describes the bill in a press release as a “state False Claims Act,” remains in the Pennsylvania Senate Health and Human Services Committee where it has been since July 23, after it received final passage in the Pennsylvania House of Representatives on July 9.

  • February 19, 2026

    Magistrate Grants Government’s Medical Records Bid In FCA Suit Over Coding ‘Fraud’

    NEW YORK — A New York federal magistrate judge on Feb. 18 granted the U.S. government’s request for medical records in its suit against Anthem Inc. alleging violations of the False Claims Act (FCA) related to alleged inaccurate diagnosis codes submitted to the Centers for Medicare & Medicaid Services (CMS) for services provided to Anthem’s Medicare beneficiaries, finding that the request is “timely” and that the records “are in fact needed.”

  • February 18, 2026

    Ga. High Court Answers State Law Certified Questions In $6M STOLI Policy Dispute

    ATLANTA — The Georgia Supreme Court on Feb. 17 answered questions certified to it from federal court and held that a third party can be found to have procured a life insurance policy when viewing the “totality of the relevant circumstances” in a trust’s suit seeking to collect death benefits on a $6 million life insurance policy the insurer claims was a stranger-originated life insurance (STOLI) policy that was procured by a third party in violation of Georgia law.

  • February 17, 2026

    N.C. High Court Won’t Stay Contempt Order Requiring Insurance Mogul To Pay $65.7M

    RALEIGH, N.C. — Without providing an explanation, the North Carolina Supreme Court on Feb. 13 denied a motion for a temporary stay of a civil contempt order requiring former insurance mogul Greg Lindberg to pay $65,775,544 and his company to pay $56,901,099 for violating a temporary restraining order (TRO) regarding conversion of assets in insurers’ breach of contract suit against Lindberg, who once owned them, and his company.

  • February 17, 2026

    Calif. Federal Judge Rules On 20 Motions In Limine In Aircraft Insurance Dispute

    SAN DIEGO — A California federal judge granted in part, denied in part and reserved ruling in part on a series of cross-motions in limine in a private jet insurance coverage dispute, excluding evidence of reinsurance and loss reserves, bifurcating punitive damages, limiting expert and regulatory evidence and reserving authentication and hearsay objections to competing insurance proposals for determination at trial.

  • February 12, 2026

    Insurers Ask N.C. Supreme Court To Decline Review Of TRO-Related Contempt Order

    RALEIGH, N.C. — Insurers in liquidation or rehabilitation that were once owned by former insurance mogul Greg Lindberg urged the North Carolina Supreme Court to deny Lindberg and his company’s petition seeking review of a lower court’s civil contempt order for violating a temporary restraining order (TRO) to prevent other entities affiliated with Lindberg and his company from dissipating assets.

  • February 11, 2026

    Judgment On The Pleadings Denied In FCA ‘Fraudulent’ Dermatology Billing Dispute

    PHILADELPHIA — A Pennsylvania federal judge on Feb. 10 denied a company and its affiliated dermatology practices’ motion for judgment on the pleadings or dismissal in a relator’s suit asserting violations of the False Claims Act (FCA) and similar state laws for the practices’ alleged fraudulent billing to receive higher reimbursements from government health insurers, finding that the FCA’s qui tam provisions “did not usurp the executive branch’s control of its enforcement priorities” and the relators’ suit “does not violate the Appointments, Vesting, and Take Care Clauses” of Article II of the U.S. Constitution.

  • February 11, 2026

    Judge Tosses FCA Suit Alleging Billing Fraud Against Life Sciences Company

    NEW YORK — A New York federal judge dismissed with leave to amend a suit alleging violations of the False Claims Act and similar New York state law against a life sciences company for purportedly fraudulently billing government insurers for COVID-19 testing, finding that the relator “failed to allege anything, much less misconduct.”