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Mealey's Insurance Fraud

  • August 26, 2025

    Judge Declines To Dismiss FCA Medicare Fraud Suit As Unconstitutional

    NEW ORLEANS — A Louisiana federal judge on Aug. 25 denied, granted and granted in part motions to dismiss a qui tam relator’s suit alleging violations of the False Claims Act (FCA) and similar state law related to medical providers’ purported submission of false claims for payment to government insurers for wound care services, denying dismissal of the complaint as unconstitutional; the judge said he “declines the invitation” by the defendants to overturn “binding precedent” establishing the constitutionality of the FCA.

  • August 26, 2025

    Over $30K Cost Reduction Recommended In Prudential Long-Term Care Fraud Suit

    ORLANDO, Fla. — A Florida federal magistrate judge issued a report and recommendation advising reducing by $30,907.95 a $63,666.67 bill of costs assessed against Florida couple after a jury awarded Prudential Insurance more than $1.9 million in its suit alleging that the couple fraudulently received benefits under their long-term care (LTC) insurance policies, finding in part that video deposition costs should not be recoverable due to in the insurer’s failure to establish that the depositions were correctly noticed for video recording.

  • August 25, 2025

    Judge Denies Insurer’s Summary Judgment Motion, Stays Sexual Abuse Coverage Suit

    LOS ANGELES — A federal judge in California denied an insurer’s motion for summary judgment in its lawsuit seeking rescission of an assisted living facility’s insurance policy and granted the insured’s motion to stay the coverage dispute until discovery is completed in an underlying action alleging that an elderly patient suffered sexual abuse while she was as a resident at the insured’s facility.

  • August 22, 2025

    6th Circuit Affirms Dismissal, Summary Judgment Rulings In FCA Medicare Row

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Aug. 21 affirmed a lower court’s rulings dismissing some claims and after discovery granting summary judgment for cancer centers and related parties in a former employee’s suit accusing the centers and related parties of violating the False Claims Act (FCA) by falsely representing that services were supervised or performed by qualified physicians and fraudulently billing Medicare and other federal insurance programs, finding in part that the lower court correctly dismissed the FCA claims regarding radiation services.

  • August 21, 2025

    Dismissal Denied In FCA Suit Alleging False Certification Of Troponin Analyzer

    ABERDEEN, Miss. — A Mississippi federal judge denied dismissal of a laboratory scientist’s suit against the hospital where she was employed, alleging that she was wrongfully discharged for reporting “illegal activity” related to a purportedly inaccurate troponin analyzer that measures troponin levels in the blood, finding that she sufficiently alleged illegal conduct regarding purported violations of the Federal False Claims Act (FCA) and related state law for which the hospital was submitting claims for payment to government and private insurers.

  • August 21, 2025

    Notice Of Compensation Hearing Issued In Insurance Magnate Money Laundering Case

    CHARLOTTE, N.C. —  In a docket-only entry, a North Carolina federal court issued a notice advising of a hearing on a court-appointed special master’s motion seeking to approve compensation for him and his advisers 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.

  • 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.