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Mealey's Insurance Fraud

  • October 17, 2024

    11th Circuit Affirms Judgment For Repair Shop In GEICO Repair Act Fraud Suit

    ATLANTA — After the Florida Supreme Court answered in the negative questions regarding whether violations under the Florida Motor Vehicle Repair Act, including failure to provide a written estimate, preclude a repair shop from receiving payment from an insurance company, the 11th Circuit U.S. Court of Appeals affirmed a district court’s judgment dismissing a claim and granting summary judgment to the repair shop on the remaining claims, partially due to GEICO’s concession that the complaint fails upon a judicial determination that “alleged Repair Act violations do not void the repair invoice.”

  • October 15, 2024

    U.S. High Court Declines To Review 7th Circuit’s Ruling Affirming FCA Liability

    WASHINGTON, D.C. —  The U.S. Supreme Court on Oct. 15 denied a petition for a writ of certiorari filed by a business owner and his three health care companies seeking review of a Seventh Circuit U.S. Court of Appeals ruling affirming a district court’s judgment finding the owner and his companies liable for violating the False Claims Act (FCA) and Anti-Kickback Statute (AKS) for fraudulent Medicare billing.

  • October 15, 2024

    Judgment Entered In Favor Of Insured In Coverage Dispute Over Fireworks Explosion

    BISMARCK, N.D.— A federal court in North Dakota entered a judgment in favor of an insured in a homeowners insurer’s declaratory judgment lawsuit disputing coverage for underlying property damage and personal injuries caused by a fireworks explosion after finding that the policy’s misrepresentation provision does not bar coverage because the insured did not willfully conceal or misrepresent any material facts regarding his use and storage of commercial fireworks at his Bismark property.

  • October 14, 2024

    Judgment Granted For Vehicle Insurer In Fraud Suit Over Driver Misrepresentation

    RIVERSIDE, Calif. — A California federal judge granted summary judgment to a motor carrier insurer in its suit seeking a determination that it is entitled to rescind its insured’s policy due to the insured’s material misrepresentation in his policy application where he omitted listing as a driver his employee who was killed in a motor vehicle accident while driving one of the insured’s vehicles.

  • October 14, 2024

    Intervention Denied In Coverage Row Over Yacht Deemed ‘Remnant Of Its Former Self’

    SAN JUAN, Puerto Rico — A Puerto Rico federal judge denied intervention in a declaratory judgment suit against an insured by parties whose boats were purportedly harmed by fire that spread from a nearby yacht the judge called a “charred remnant of its former self,” finding that the proposed intervenors failed to establish that their interests “are not adequately represented by the defendant.”

  • October 10, 2024

    Standing, Adequacy Of RICO Allegations Disputed In Reinsurer’s Lawsuit

    BROOKLYN, N.Y. — A New York federal judge has dismissed a Racketeer Influenced and Corrupt Organizations (RICO) Act lawsuit without prejudice against more than a dozen defendants that a reinsurer alleged took part in purportedly fraudulent workers’ compensation claims and personal injury lawsuits.

  • October 10, 2024

    Claims Objection Bar Date Extension Granted In Liquidation Of Vesttoo

    WILMINGTON, Del. — A Delaware federal bankruptcy judge has granted a motion to extend the claims objection bar date by 180 days to April 7 in the Chapter 11 liquidation of Vesttoo Ltd. and its dozens of affiliates.

  • October 10, 2024

    Bar Seeks 8th Circuit Reversal In Fire Damage Coverage Row, Cites Scope Of Actions

    MINNEAPOLIS — A corporation operating a bar and the former spouse of the bar’s prior owner, who pleaded guilty to arson for the fire that destroyed the bar, filed a reply brief in the Eighth Circuit U.S. Court of Appeals urging the court to reverse a district court’s grant of summary judgment to the bar’s insurer upon finding that the arsonist’s false statements to defraud the insurer were imputed to the bar.

  • October 09, 2024

    Judge Rules On Report And Recommendation In FCA Nursing Home Staffing Dispute

    PHILADELPHIA — A Pennsylvania federal judge adopted in part a special master’s report and recommendation in a relator’s qui tam suit against Kindred Healthcare Inc. and its subsidiaries, alleging that they misrepresented their compliance with staffing requirements to receive larger reimbursements from Medicare and Medicaid, overruling the relator’s objections to the recommendation that discovery be limited to medical records related to providing services regarding activities of daily living.

  • October 08, 2024

    Complaint Unsealed In FCA Suit Accusing Assisted Living Provider Of Medicaid Fraud

    NEW YORK — A New York federal judge unsealed a qui tam complaint filed by a relator asserting that a New York state assisted living provider violated the federal False Claims Act (FCA) and similar New York state law and defrauded Medicaid by falsely inflating residents’ level of care scores to increase per diem Medicaid capitated billing rates.

  • October 07, 2024

    Judge Denies Motion To Strike As ‘Highly Inappropriate’ In GEICO’s PIP Fraud Suit

    FORT LAUDERDALE, Fla. — A Florida federal judge denied a physical therapy provider’s motion to strike in a suit filed by GEICO against it and other entities alleging that the defendants submitted more than $2.8 million in fraudulent charges for unnecessary services for personal injury protection (PIP) insurance charges, finding that the defendants’ request to strike pages of GEICO’s reply brief supporting its partial summary judgment motion “is a highly inappropriate request” without supporting legal authority.

  • October 07, 2024

    U.S. Supreme Court Denies Cert In FCA, Anti-Kickback Violations Row

    WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied certiorari of a qui tam relator’s petition seeking review of a Second Circuit U.S. Court of Appeals ruling affirming a district court’s dismissal of federal False Claims Act (FCA) suit alleging violations of the Anti-Kickback Statute (AKS), where the relator argued for review to resolve the split between circuit courts regarding whether knowledge that a party’s conduct violates the law is required to show willfulness pursuant to the AKS.

  • October 07, 2024

    U.S. Supreme Court Denies Certiorari In FCA Public Disclosure Bar Dispute

    WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied a petition for certiorari filed by pharmaceutical companies seeking review of the Ninth Circuit U.S. Court of Appeals’ ruling that the public disclosure bar was not triggered in a case where it reversed a district court’s dismissal of a suit accusing the companies of violating the False Claims Act (FCA) by artificially inflating drug prices.

  • October 07, 2024

    U.S. High Court Won’t Review Ruling Upholding FCA Settlement Agreement Orders

    WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 7 denied a petition for writ of certiorari filed in the U.S. Supreme Court by the owner of medical clinics seeking review of the Sixth Circuit U.S. Court of Appeals’ ruling upholding a district court’s orders enforcing a settlement agreement and compelling the owner to seek U.S. government consent to dismiss claims for federal False Claims Act (FCA) violations in a separate qui tam suit.

  • October 07, 2024

    Judge: Insurer Will ‘Quibble’ With Analysis In $2M Life Policy Ruling For Spouse

    SEATTLE — A Washington state federal judge denied a life insurer’s motion for summary judgment but granted a cross-motion for summary judgment by a decedent’s spouse and beneficiary of the decedent’s $2 million life insurance policy, finding that though the insurer “will quibble with” the interpretation of the policy application where the insured answered “no” to questions about visiting his physician but did visit his dentist, “there is no dispute that ‘physician’ is at least ‘fairly susceptible’ to two interpretations” in the insurer’s suit seeking to rescind the policy due to the insured’s purported  material misrepresentations.

  • October 03, 2024

    Discovery Ruling Issued In Insurance Fraud Suit Seeking Relief Under ERISA, UCL

    LOS ANGELES — A California federal magistrate judge substantially granted a motion to compel discovery filed by a cheese manufacturing company in its suit against surgery centers for alleged fraudulent billing for health care plan benefits related to unnecessary or unperformed medical services, restitution under the Employee Retirement Income Security Act (ERISA) and violations of California’s unfair competition law (UCL), finding in part that the defendants’ privacy concerns are outweighed by the need for the discovery information that will be reviewed under a stipulated protection order that will address those concerns.

  • October 03, 2024

    Lab Testing Company Settles FCA Unnecessary Testing Allegations For $27M

    WASHINGTON, D.C.  — The U.S. Department of Justice (DOJ) on Oct. 2 announced that Precision Toxicology LLC, a urine drug testing toxicology laboratory, agreed to pay $27 million to resolve allegations that it violated the False Claims Act (FCA) and similar state false claims statutes for its role in billing Medicare, Medicaid and other federal insurers for medically unnecessary urine drug tests and for providing remuneration to physicians who agreed to refer laboratory testing to Precision.

  • October 03, 2024

    Insurer Calls Motion ‘Self-Serving’ In $2M Life Policies Misrepresentation Row

    MACON, Ga. —  Pacific Life Insurance Co. filed a response brief in a Georgia federal court asking the court to deny a motion in limine filed by the beneficiary of two $1 million life insurance policies who is seeking to exclude evidence that the insurer would have issued the policies at a different premium had it known of the policy application misrepresentations.

  • October 02, 2024

    Insurer Seeks To Rescind Rider Of $200K Life Policy Over Health Misrepresentations

    CHICAGO — Transamerica Life Insurance Co. on Oct. 1 filed a complaint in an Illinois federal court against its insured and the owner of a $200,000 life insurance policy with a long-term care (LTC) rider after they submitted a claim for LTC benefits due to the insured’s degenerative brain disorder, seeking a declaratory judgment that the policy is rescinded due to the defendants’ alleged material misrepresentations regarding the insured’s treatment for cognitive disorders when medical records showed that he had undisclosed cognitive deficits resulting from a prior coma.

  • October 02, 2024

    Florida Federal Judge Tosses FCA Suit For ‘Unconstitutional’ Qui Tam Appointment

    TAMPA, Fla. — Drawing on a dissent issued by U.S. Supreme Court Justice Clarence Thomas in United States ex rel. Jesse Polansky, M.D., M.P.H. v. Executive Health Resources, a Florida federal judge on Sept. 30 granted defendants’ dismissal motion in a qui tam suit alleging that medical providers and Medicare Advantage (MA) insurers violated the False Claims Act (FCA), finding that the relator lacks standing pursuant to Article II of the U.S. Constitution to pursue a qui tam action on the government’s behalf.

  • September 26, 2024

    Claims Objection Bar Date Extension Sought In Liquidation Of Vesttoo

    WILMINGTON, Del. — A Delaware federal bankruptcy judge has been asked to extend the claims objection bar date by 180 days in the Chapter 11 liquidation of Vesttoo Ltd. and its dozens of affiliates.

  • September 23, 2024

    Panel Reverses, Says Insurer Failed To Show It Was Entitled To Rescind Policy

    DETROIT — A Michigan appellate court reversed and remanded a lower court’s ruling that granted a no-fault insurer’s motion for summary disposition in a suit against it by its insured, seeking benefits related to an auto accident, finding that the insurer cannot show injury due to the insured’s misrepresentation in her policy application regarding household members absent evidence showing that without the misrepresentation, it would not have issued the policy or would have charged a higher premium.

  • September 23, 2024

    Confidentiality Stipulation Filed In $300M Ponzi Fraud Case Involving Insurers

    MIAMI — Plaintiffs and defendant Wells Fargo filed a confidentiality stipulation in a Florida federal court in a putative class action suit alleging that Wells Fargo aided and abetted fraud in a “massive” Ponzi scheme purportedly orchestrated by owners of insurers, some of whom 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).

  • September 20, 2024

    Summary Judgment Granted To Insurer For ‘Legal Fraud’ In Insurance Application

    TUCSON, Ariz. — An Arizona federal judge granted summary judgment to a homeowners insurer in its suit seeking to rescind its insured’s policy for material misrepresentation in the insurance application, finding that the insured’s misrepresentation that the property was his primary residence and failure to correct the policy’s terms representing this residency “constitute legal fraud,” thereby making rescission “proper.”

  • September 18, 2024

    8th Circuit Affirms Dismissal Of FCA Suit Alleging Medicare Advantage Fraud

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals affirmed a district court’s dismissal of a qui tam plaintiff’s suit asserting False Claims Act (FCA) violations against a marketing organization and health insurers related to their alleged falsification of insurance agent certifications required by the Centers for Medicare and Medicaid Services (CMS) and violations of Medicare Advantage marketing regulations, finding that the lower court did not err in dismissal because none of the marketing organization’s “alleged schemes are material to CMS’s” agreement with the insurers.