Mealey's Insurance Fraud

  • September 04, 2026

    Company’s Motion To Compel Discovery Of Documents Denied In Fire Coverage Row

    DENVER — A Colorado federal magistrate judge denied a company’s motion to compel discovery of communications an insurer has withheld under the Colorado Fraudulent Claims and Arson Information Reporting Act (AIA) in the company’s suit against its businessowners insurer for breach of contract and statutory bad faith for its purported failure to cover a claim for fire damage to her retail store, finding that the insurer has met its burden to protect the documents at issue from production.

  • September 03, 2026

    11th Circuit Won’t Rehear Ruling Affirming Dismissal Of FCA Post-Settlement Suit

    ATLANTA — The 11th Circuit U.S. Court of Appeals on Sept. 2 denied a petition for rehearing en banc of the court’s ruling affirming the dismissal of a couple’s suit under the False Claims Act (FCA) and the Medicare Secondary Payer Act (MSPA) alleging that insurers caused a man’s healthcare providers to present false claims to the Centers for Medicare & Medicaid Services (CMS) and that by hiding purported responsibility as primary payers, the insurers forced the couple to reimburse CMS for post-settlement medical care.

  • September 03, 2026

    Life Insurer Seeks To Rescind $100K Policy For Alleged Misrepresentations

    BOSTON — A life insurer filed a complaint in Massachusetts federal court seeking to rescind a $100,000 life insurance policy for purported misrepresentations in the policy application, asserting that had the insured accurately reported his medical history of possible prostate cancer, the policy would not have been issued under the same terms or at all.

  • September 02, 2026

    11th Circuit Says FCA Qui Tam Provisions Don’t Violate Appointments Clause

    ATLANTA — The 11th Circuit U.S. Court of Appeals on Sept. 1 vacated a lower court order dismissing a qui tam suit alleging that medical providers and Medicare Advantage (MA) insurers violated the False Claims Act (FCA) and remanded, finding that the FCA’s qui tam provisions do not violate the appointments clause of Article II of the U.S. Constitution.

  • September 01, 2026

    Dismissal Denied In Dispute Over $100M Allegedly Depleted From Reinsurance Trust

    NEW YORK — A New York federal judge on Aug. 31 denied dismissal to a reinsurer and other parties that an insurer accused of improperly depleting a reinsurance trust account by more than $100 million, finding that the insurer has standing to sue because the trust agreement provided it with the right to withdraw trust assets at any time.

  • September 01, 2026

    2nd Circuit Affirms Direct FCA Claims Dismissal, Vacates Reverse FCA Claim Ruling

    NEW YORK — The Second Circuit U.S. Court of Appeals vacated a lower court’s dismissal of a reverse false claim and remanded for further proceedings but affirmed a lower court’s judgment dismissing direct false claims in a relator’s suit alleging that a pharmacy services provider overcharged certain government health care programs in violation of the False Claims Act (FCA) and related state law, finding that the relator failed to satisfy the specificity required regarding the direct claims but sufficiently alleged a reverse false claim.

  • August 28, 2026

    10th Circuit Affirms Ruling Granting Judgment For Insurers In FCA Medicaid Dispute

    DENVER — The 10th Circuit U.S. Court of Appeals affirmed a lower court’s dismissal and summary judgment orders in a qui tam suit filed against insurers alleging false representations in their bid to administer state behavioral health services, including those funded by Medicaid, finding that the relator failed to establish the element of scienter required under state law and the False Claims Act (FCA).

  • August 28, 2026

    Dismissal Denied, FCA Case Stayed Pending 11th Circuit Ruling On Qui Tam Provision

    FORT MYERS, Fla. — Denying the motions to dismiss without prejudice and staying a relator’s suit alleging that a hospital, physician practice group and a health care management company violated the False Claims Act (FCA) and related Florida law by billing government insurers for admissions of noncritical patients to the intensive care unit (ICU), a Florida federal judge found that a forthcoming decision by the 11th Circuit in United States ex rel. Zafirov v. Florida Medical Associates, LLC “will undoubtedly (and substantially)” impact the relator’s claims.

  • August 25, 2026

    Quash Motions Partially Granted In FCA Vision Drug Pricing Suit Against Regeneron

    BOSTON — A Massachusetts federal magistrate judge on Aug. 24 granted in part nonparty pharmaceutical manufacturers’ motions to quash subpoenas in a suit against Regeneron Pharmaceuticals Inc. alleging violations of the federal False Claims Act (FCA) and similar state laws for purportedly fraudulent sales price reporting for a vision impairment drug, finding that the evidence sought could be relevant to scienter.

  • August 20, 2026

    Split 9th Circuit Reinstates FCA Claims As To Regeneron, Affirms Sanofi Dismissal

    SAN FRANCISCO — A split Ninth Circuit U.S. Court of Appeals on Aug. 19 found that a lower court erred in dismissing False Claims Act (FCA) claims against Regeneron Pharmaceuticals Inc. because claims that the company violated the Anti-Kickback Statute (AKS) by paying physicians to prescribe its drugs were adequately pleaded; the court affirmed dismissal of the FCA conspiracy claim against Regeneron and dismissal of all claims against Sanofi Aventis US LLC.

  • August 19, 2026

    7th Circuit Affirms Ruling Tossing FCA Suit Alleging Medicare Prescription Fraud

    CHICAGO — The Seventh Circuit U.S. Court of Appeals affirmed a lower court ruling dismissing a relator’s complaint alleging violations of the False Claims Act (FCA), finding that the relator failed to plead with particularity the allegations regarding submitting claims to Medicare based on fraudulent prescriptions and that the complaint failed “to allege materiality.”

  • August 18, 2026

    Summary Judgment Granted For Hospitals In FCA Dispute Over Medicaid Funding

    ORLANDO, Fla. — A Florida federal judge granted summary judgment for hospitals in a relator’s suit against them alleging violations of the False Claims Act (FCA) and similar state law for purportedly forming interlocal agreements involving Florida’s Low Income Pool Program (LIP), a hospital reimbursement program for Medicaid services, finding that the claims are barred by the public disclosure bar in part because the agreements were publicly filed with a Florida county court clerk.

  • August 17, 2026

    Split 9th Circuit Gives DOJ Win In Gender-Affirming Care Subpoena Dispute

    SEATTLE — Giving the U.S. Department of Justice (DOJ) a victory on an issue that is the focus of numerous lawsuits, the Ninth Circuit U.S. Court of Appeals on Aug. 14 issued a 2-1 ruling reversing quashal of an administrative subpoena for patient medical and communications data from a gender-affirming care provider and remanding for further proceedings; the majority concluded that the provider “has not met its heavy burden of showing that the subpoena was issued for an improper purpose,” and the dissenter said, “That the President may lawfully voice policy opposition to a practice does not mean the DOJ can exceed its statutory authority and issue pretextual subpoenas to put a company out of business.”

  • August 13, 2026

    Mich. Panel Affirms Ruling Denying Summary Disposition To CURE Auto In PIP Dispute

    LANSING, Mich. — A Michigan appellate court affirmed a lower court ruling denying summary disposition to CURE Auto Insurance and granting summary disposition to Allstate in a dispute over personal injury protection (PIP) coverage, finding that the lower court correctly ruled that there is no evidence that the driver seeking coverage participated in fraudulently obtaining a policy from CURE.

  • August 12, 2026

    Dismissal Denied In Marine Coverage Dispute Over Lightning Damage To Yacht

    FORT MYERS, Fla. — A Florida federal judge on Aug. 11 denied a motion to dismiss filed by insureds in a marine insurer’s suit seeking a declaration that there is no coverage for lightning damage to a yacht because the insureds allegedly breached the policy’s fraud provision by failing to disclose a prior marine claim for hurricane damage, finding that the insureds’ argument that the policy must be reformed for mutual mistake addresses a fact dispute that courts do not resolve at the dismissal stage of the litigation.

  • August 11, 2026

    Dismissal Denied In Sex Discrimination, FCA Suit Against Pharmaceutical Company

    NEW YORK — A New York federal judge on Aug. 10 denied a pharmaceutical company’s motion to dismiss a suit filed against it by a former sales representative who alleges that the company violated the False Claims Act (FCA), similar state law and state sex discrimination laws by firing her after she complained about being forced to work in a “sexually charged environment,” finding that the former representative plausibly alleged protected activity under the FCA.

  • August 11, 2026

    In Insurance Coverage Case With ‘Strange History,’ Judge Grants Default Judgment

    PHOENIX — Finding default judgment appropriate, an Arizona federal judge granted default judgment to an insurer in a case the judge deemed as having a “strange history” in which a named insured replaced the original plaintiff after the breach of contract suit was removed to federal court after which the insurer filed counterclaims for rescission and declaratory judgment based upon purported misrepresentations in the insurance application.

  • August 10, 2026

    Judge Grants Partial Dismissal In FCA Row With Hospital, Staffing Group, Doctors

    LOS ANGELES — A California federal judge granted in part and denied in part dismissal to physicians, a hospital and a hospitalist staffing group accused of violating the False Claims Act (FCA) and related California law by participating in a scheme of kickbacks for alleged unnecessary hospital admissions, dismissing most federal and state law claims while allowing retaliation claims against the staffing group and two of its physicians to proceed, finding that the relator adequately alleged causation, protected activity and employer knowledge for the retaliation claims against those defendants.

  • August 07, 2026

    Dismissal Of Counterclaim Denied In Hurricane Coverage Dispute Over Prior Damage

    TAMPA, Fla. — A Florida federal judge denied insureds’ motion to dismiss their insurer’s counterclaim seeking a declaration that it has no obligation to provide coverage for purported damage caused by Hurricane Milton, rejecting the insureds’ argument that the counterclaim is redundant and finding that the counterclaim seeks different relief than the insureds’ claim.

  • August 06, 2026

    3rd Circuit Affirms Dismissal Of FCA Retaliation Claim Against Device Maker

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals affirmed a lower court’s dismissal of a former employee’s False Claims Act (FCA) retaliation suit against the medical device company that terminated his employment, finding that the operative complaint failed to allege that the former employee held the belief that the employer submitted or would submit fraudulent claims to the government for payment.

  • August 04, 2026

    Businessman Expands Claims In $34.4M Guaranty Enforcement Countersuit

    NEW YORK — A businessman and the borrower he controls filed amended counterclaims and a third-party complaint in a New York federal court in a $34.4 million guaranty enforcement action, alleging that the lender and related entities helped conceal deficiencies in structured settlement receivables and then attempted to shift the resulting losses to the businessman.

  • August 03, 2026

    8th Circuit Affirms Fraud Suit Dismissal Against Oncology Drugs Distributor

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on July 31 affirmed a lower court’s dismissal of a suit filed by United Healthcare Services Inc. (UHS) accusing a drug distributor of participating in a “scheme” to repackage and sell oncology drugs to second purchasers, resulting in excessive billing to health insurers, finding that the suit was untimely under the applicable statute of limitations.

  • July 31, 2026

    8th Circuit Affirms Judgment For Life Insurer In Dispute Over $4M STOLI Policy

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on July 30 affirmed a lower court’s ruling granting summary judgment to a life insurer in a breach of contract and bad faith suit over the insurer’s failure to pay the death benefits under a $4 million life insurance policy, finding that the policy was void as a stranger-originated life insurance (STOLI) policy because the policy was procured with the intent to benefit persons lacking an insurable interest in the insured’s life under New Jersey law.

  • July 30, 2026

    Magistrate Denies, Takes Under Advisement Motion To Compel In FCA Billing Dispute

    MINNEAPOLIS — In a relator’s qui tam suit alleging violations of the False Claims Act (FCA) and related Minnesota law, a Minnesota federal magistrate judge denied portions of the relator’s second motion to compel seeking to expand the temporal and substantive scope of discovery as lacking relevance but took under advisement requests for production related to audits of claims to government payers, pending a supplemental declaration identifying dates of the audit.

  • July 28, 2026

    Panel Affirms Order Clarifying Application Of Policy Rescission To PIP Coverage

    DETROIT — A Michigan appellate court on July 24 affirmed a lower court order clarifying its ruling on the insurer’s rescission of the policy and its application to personal injury protection (PIP) obligations, finding that the insurer’s challenge to a $250,000 limit on allowable-expense coverage was not preserved for appeal because the insurer’s complaint sought rescission only and did not seek a declaration regarding coverage limits.