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Mealey's Insurance Fraud

  • 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.

  • June 04, 2025

    Judge Denies CEO Dismissal Bid In FCA Suit Against Lab Alleging Illegal Kickbacks

    SHERMAN, Texas — A Texas federal judge denied a dismissal motion filed by the CEO of a former laboratory accused, along with other individuals and entities, of violating the federal False Claims Act (FCA) and Anti-Kickback Statute (AKS) through payment of illegal kickbacks to doctors and medical practices and fraud against government insurers by billing them for medically unnecessary tests, finding that “dismissal is not warranted.”

  • June 02, 2025

    Panel Affirms Ruling Granting Summary Disposition For Insurer In PIP Dispute

    DETROIT — A Michigan appellate court affirmed a lower court ruling granting summary disposition in favor of an insurer in a personal injury protection (PIP) dispute between an insurer and a man injured in an auto accident seeking no-fault coverage, finding “no genuine issue of material fact that plaintiff committed a fraudulent insurance act.”

  • May 30, 2025

    Insurance Magnate Files Objections To Presentence Report In Money Laundering Case

    CHARLOTTE, N.C. — Insurance magnate Greg Lindberg filed under seal objections to a presentence investigation report after he 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.

  • May 29, 2025

    Magistrate Recommends Granting Judgment To Life Insurer In Row Over $400K Policy

    FORT MYERS, Fla. — A Florida federal magistrate judge on May 28 issued a report and recommendation advising granting default judgment to an insurer in its suit seeking to rescind a $400,000 life insurance policy for alleged policy application material misrepresentations regarding health status, finding that because the allegations in the complaint are deemed admitted by the insured’s default, the insurer is permitted to rescind the policy.

  • May 28, 2025

    Majority Reverses Punitive Damages Ruling In Suit Arising From Hurricane Florence

    RALEIGH, N.C. — A majority of the North Carolina Supreme Court affirmed an appeals court majority’s holding that an insured’s allegations are sufficient to state a claim for negligence against an insurance agent in a lawsuit arising from Hurricane Florence property damage but  reversed its ruling as to the punitive damages claim.

  • May 28, 2025

    Motion To Set Aside Default Granted For ‘Good Cause’ In FCA Retaliation Suit

    RALEIGH, N.C. — A North Carolina federal judge on May 27 granted a dermatology practice’s motion to set aside the court clerk’s entry of default in a former employee’s suit accusing the practice of violating the federal False Claims Act (FCA) by terminating his employment in retaliation for complaints about purported fraudulent billing to Medicare, finding “good cause” to set aside the entry of default for delays that seem to be the fault of the practice’s prior attorney.

  • May 28, 2025

    After Reversal, Judge Orders Reopening Of FCA Suit Over CPAP Billing To Tricare

    ATLANTA —  On remand from the 11th Circuit U.S. Court of Appeals’ partial reversal of a district court’s order dismissing a qui tam complaint against a company and its subsidiary supplier of continuous positive air pressure (CPAP) sleep apnea devices, a Florida federal judge ordered reopening of the suit alleging violations of the federal False Claims Act (FCA) for purported fraudulent billing to government health insurers, including Tricare

  • May 27, 2025

    Connecticut Judge Grants Strike Motion In Father And Son Life Insurance Dispute

    DANBURY, Conn. — A Connecticut state court judge granted a motion to strike a complaint’s single claim of intentional misrepresentation in a dispute between a father and son over the son’s alleged fraud in forging his father’s signature on a life insurance application, finding that the father failed to plead the required elements for an intentional misrepresentation claim.

  • May 23, 2025

    Protective Order Motion Denied In Insurance Coverage Dispute Over Maserati Loss

    INDIANAPOLIS — Denying a motion for a protective order on May 22, an Indiana federal magistrate judge said an insured suing State Farm over its alleged bad faith failure to compensate him for the loss of his Maserati must respond to State Farm’s discovery requests because the insured failed “to show the good cause required to obtain the requested protective order.”

  • May 23, 2025

    Motion To Amend Granted In Insurance Coverage Dispute Over Misrepresentations

    SALT LAKE CITY — A Utah federal magistrate judge granted insureds’ motion to amend in a commercial general liability insurer’s suit seeking a declaration that it owes no duty to defend the insureds in underlying litigation based upon alleged misrepresentations in the insurance application, finding that the insureds have shown good cause to file an amended answer due to the insurer purportedly not timely notifying them of its intention to seek rescission.

  • May 20, 2025

    Judge Grants GEICO’s Motion To Stay Other Suits In RICO Case Against Providers

    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 on May 19 granted GEICO’s motion for a preliminary injunction to stay pending no-fault collection arbitration and state court suits and enjoin the filing of similar actions against GEICO by those providers, finding that pursuant to a recent ruling by the Second Circuit U.S. Court of Appeals, district courts can enjoin state court proceedings.

  • May 20, 2025

    Clerk Issues Summons In Liberty Mutual No-Fault Fraud Suit Against Pharmacies

    CENTRAL ISLIP, N.Y. — A New York federal court clerk on May 19 issued a summons to pharmacies and their owners that were sued by Liberty Mutual for alleged Racketeer Influenced and Corrupt Organizations (RICO) Act violations for their purported participation in a no-fault insurance “scheme” to defraud Liberty Mutual by billing it for unnecessary pain-relief products for claimants involved in auto accidents.

  • May 16, 2025

    Connecticut Federal Judge Grants Judgment For LLC In Fire Coverage Row With AIG

    BRIDGEPORT, Conn. — A Connecticut federal bankruptcy judge on May 15 granted in part a motion for partial summary judgment filed by a limited liability company seeking a declaratory judgment that property insurer AIG Property Casualty Co. owes a duty to cover fire-related losses for an apartment leased by the company, finding that AIG has a duty to the company to pay its losses regarding the apartment and that AIG failed to show that the company materially misrepresented its ownership.

  • May 15, 2025

    Magistrate Says Judge Should Deny Motion To Set Aside In Allstate RICO Suit

    AUSTIN, Texas — A Texas federal magistrate judge issued a report and recommendation advising that a district court judge should deny a motion to set aside a court clerk’s entry of default against a man accused of participating in a Racketeer Influenced and Corrupt Organizations (RICO) Act conspiracy to defraud Allstate in a purported scheme where the man, his companies and related parties engaged in hazardous material cleanups that were allegedly unnecessary or did not involve Allstate insureds, finding that the man’s lack of compliance with court orders was “willful.”

  • May 14, 2025

    Wisconsin Panel Affirms Judgment For Insurer In Fire Coverage Dispute With Insured

    WAUSAU, Wis. — A Wisconsin Court of Appeals on May 13 affirmed a lower court’s grant of summary judgment to a homeowners insurer in a dispute over coverage for wood stove-related fire damage and alleged misrepresentations about the usability of the stove, finding that the insured breached his insurance policy by not sitting for an examination under oath (EUO) before suing his insurer.

  • May 14, 2025

    California Panel Reverses, Remands Ruling On Insurer’s Fraudulent Concealment Claim

    LOS ANGELES — A California appeals court panel reversed a lower court’s ruling as to a plaintiff insurer’s fraudulent concealment claim against a defendant insurer in a coverage dispute over underlying claims that their mutual insured manufactured defective air respirators and masks that did not protect against inhaling silica, asbestos and mixed dust, remanding for a new trial on the fraudulent concealment claim.

  • May 13, 2025

    Judge Denies Dismissal Of FCA Suit Alleging Upcoding In Emergency Department

    SAN FRANCISCO — A California federal judge dismissed with prejudice only non-California state law claims against a California-based provider of emergency medical services but otherwise denied dismissal in a qui tam suit alleging that the provider and a national medical management company violated the federal False Claims Act (FCA) and similar state laws by fraudulent upcoding when submitting claims for payment to government insurers, finding that the “relator has plausibly alleged that the fraudulent scheme at issue” extends outside the hospital.

  • May 13, 2025

    Magistrate: Motion For Judgment Should Be Denied In Federal False Claims Dispute

    BUFFALO, N.Y.  — A New York federal magistrate judge recommended denying an insurer’s motion for judgment on the pleadings and to amend its answer to assert a constitutionality challenge to a qui tam suit filed on behalf of the federal government and the state of New York alleging violations of the federal False Claims Act (FCA) and similar state law related to purportedly inflated Medicaid premiums, finding no “merit” to the constitutional challenge.

  • May 12, 2025

    Nebraska High Court Reverses Judgment For Ex-Employee In Medicare Fraud Dispute

    LINCOLN, Neb. — The Nebraska Supreme Court on May 9 reversed and remanded a judgment for a former employee in her suit alleging that she was terminated because she intended to cooperate with a federal investigation into her former employer’s alleged improper upcoding of Medicare charges, finding that the lower court should have granted the employer’s motion for a directed verdict because there is no cause of action for wrongful termination in violation of public policy when the statute on which the policy is based, the federal False Claims Act (FCA), has its own remedy.

  • May 12, 2025

    High Court Review Sought Of Ruling Affirming Judgment In Insurance Fraud Dispute

    WASHINGTON, D.C.  —  A company once owned by a man convicted in an insurance fraud scheme and over which a limited liability company (LLC) obtained an insurance fraud judgment in a New York federal court filed a petition for writ of certiorari in the U.S. Supreme Court seeking review of a 10th Circuit U.S. Court of Appeals decision affirming an Oklahoma federal court ruling granting summary judgment in favor of the LLC seeking to enforce the $6.7 million judgment in Oklahoma federal court.

  • May 09, 2025

    3rd Circuit Won’t Rehear Ruling Affirming Dismissal Of FCA Suit Over Antibiotics

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals denied a petition for rehearing and rehearing en banc of its ruling affirming a lower court’s dismissal of a qui tam relator’s suit against Bayer Corp., Johnson & Johnson, Merck & Co. and other pharmaceutical companies, alleging that “hiding” side effects of their antibiotics from the U.S. Food and Drug Administration “caused fraudulent claims to be submitted to Medicaid and Medicare.”