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Mealey's Insurance Fraud

  • December 09, 2025

    Split Ohio High Court Indefinitely Suspends Attorney Convicted Of Insurance Fraud

    COLUMBUS, Ohio — A split Ohio Supreme Court adopted the state Board of Professional Conduct’s misconduct findings related to an attorney convicted of insurance fraud but rejected the board’s recommended one-year suspension sanction, finding that the attorney’s “fraudulent scheme of falsely inflating $859,464.44 worth of clients’ medical bills to increase the amount he received in bonuses warrants an indefinite suspension from the practice of law.”

  • December 09, 2025

    11th Circuit Grants U.S. Chamber Oral Argument Bid In FCA Constitutionality Case

    ATLANTA — The 11th Circuit U.S. Court of Appeals granted a motion by the U.S. Chamber of Commerce to participate in oral arguments in the appeal of a district court ruling dismissing a qui tam suit alleging that medical providers and Medicare Advantage (MA) insurers violated the False Claims Act (FCA) upon finding that the FCA’s qui tam provision violates the appointments clause of Article II of the U.S. Constitution.

  • December 05, 2025

    Judge Denies Motions To Exclude Expert Testimony In FCA Urine Test Billing Suit

    HAMMOND, Ind. — An Indiana federal judge on Dec. 4 denied motions to exclude expert testimony in a suit by Indiana and the U.S. government against a medical center and its owner alleging violations of the federal False Claims Act and similar state law regarding alleged fraudulent billing to Medicaid for urine drug screening tests, finding that the experts were qualified and used reliable methodology.

  • December 05, 2025

    1st Circuit Tosses Appeal Of Judgment For Insurer In Yacht Fire Damage Dispute

    BOSTON — After the parties filed a joint stipulation of voluntary dismissal, the First Circuit U.S. Court of Appeals dismissed the appeal of a ruling granting in part summary judgment to a yacht insurer in a fire coverage dispute in which the insurer sought to void the policy for purported material misrepresentations in the policy application.

  • December 04, 2025

    Judgment Denied For State Farm In Fire Coverage Dispute Over Misrepresentations

    SCRANTON, Pa. — A Pennsylvania federal judge on Dec. 3 denied summary judgment to State Farm in a breach of contract suit over State Farm’s alleged failure to cover an insured’s fire damage claim, finding that the insured’s testimony during an examination under oath (EUO) creates a dispute of fact regarding whether he made false statements in bad faith as to his knowledge of judgments exceeding $100,000 against him.

  • December 04, 2025

    Magistrate Recommends Denying Dismissal, Joinder In Policies Rescission Suit

    OPELIKA, Ala. — An Alabama federal magistrate judge recommended denying dismissal and joinder of an insurance brokerage as a defendant in an insurer’s suit seeking to rescind its insured’s policies for purported material misrepresentations regarding the nature of the insured’s business, finding that the brokerage is not a required party.

  • December 03, 2025

    Partial Dismissal Granted In Workers’ Compensation Policy ‘Misrepresentation’ Row

    CAMDEN, N.J. — A New Jersey federal judge granted in part dismissal to a staffing agency and its owner in a breach of contract and statutory violations suit against them by a workers’ compensation insurer related to allegations of misrepresentations to obtain lower premiums, also finding that the statutory fraud claims can proceed because they are related to statutory duties.

  • December 02, 2025

    In ‘First Impression’ FCA Medicare Suit, 1st Circuit Affirms Judgment For Lab

    BOSTON — The First Circuit U.S. Court of Appeals on Dec. 1 affirmed a district court’s grant of summary judgment to a lab and its owners in a medical practice’s qui tam suit alleging violations of the False Claims Act (FCA) and similar state laws related to billing Medicare for alleged medically unnecessary urinary tract infection (UTI) testing, finding that the medical practice failed to show that the lab and its owners should have known the tests were not medically necessary.

  • December 02, 2025

    Judge Denies Stay Pending Recusal Denial Challenge In FCA Covid Testing Fraud Suit

    NEW YORK — A New York federal judge denied a motion by a lab and related parties to stay pending a petition for a writ of mandamus challenging the judge’s ruling denying 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, finding that the defendants failed to show irreparable harm absent a stay.

  • December 01, 2025

    Discovery Motion Denied For Lack Of Good Cause In FCA Suit Over Coding ‘Fraud’

    NEW YORK — A New York federal magistrate judge denied a motion by insurer Anthem Inc. seeking to serve a request for production (RFP) on the U.S. government in its suit against Anthem alleging violations of the federal 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 Anthem failed to show good cause for the RFP request.

  • November 26, 2025

    New York High Court Answers ‘Misconduct’ Denial Question In $6.6M No-Fault Dispute

    NEW YORK —  A split New York Court of Appeals answered in the negative a question certified to it by the Second Circuit U.S. Court of Appeals regarding whether an insurer can deny a provider’s claim for no-fault benefit payments for the provider’s alleged misconduct in paying for patient referrals related to an appeal of a ruling awarding GEICO $6,616,142.68 in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit.

  • November 24, 2025

    U.S. Supreme Court Won’t Rehear Cert Denial In Insurance Fraud Judgment Row

    WASHINGTON, D.C. — The U.S. Supreme Court on Nov. 24 denied rehearing of its order denying a petition for a writ of certiorari filed by a company whose former owner was convicted in an insurance fraud scheme and over which a limited liability company (LLC) obtained an insurance fraud judgment, 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.

  • November 24, 2025

    Panel Denies Insurer’s Reconsideration Bid In Auto Accident Coverage Dispute

    YOUNGSTOWN, Ohio — An Ohio appellate court denied an auto insurer’s motion for reconsideration of the court’s ruling that reversed and remanded a lower court’s judgment in favor of the auto insurer regarding coverage for an auto accident that injured four bystanders, finding that the court already considered the insurer’s arguments.

  • November 21, 2025

    11th Circuit Affirms Judgment For Psychiatry Center In FCA Retaliation Suit

    ATLANTA — The 11th Circuit U.S. Court of Appeals affirmed a lower court ruling granting summary judgment for a psychiatry center in a former employee’s suit alleging that the center violated the federal False Claims Act by retaliating against him for advising a judge that the center allegedly colluded with a hospital to defraud Medicare and Medicaid, finding that the former employee failed to rebut the center’s explanations for terminating him.

  • November 18, 2025

    Insurer Appeals Decision Finding Rescission Of Contractor’s Policy Time-Barred

    LOS ANGELES — An insurance company has appealed a California federal judge’s order denying its motion for judgment on the pleadings and granting summary judgment sua sponte in favor of a general contractor; the judge found that the insurer’s claim for rescission of the general contractor’s policies because the general contractor provided false information on its insurance applications was time-barred.

  • November 18, 2025

    Relator Seeks Rehearing Of 5th Circuit Ruling Affirming Dismissal Of FCA Suit

    NEW ORLEANS — A qui tam relator filed a petition for panel rehearing of a Fifth Circuit U.S. Court of Appeals ruling affirming a lower court’s dismissal of the relator’s complaint as “insufficiently plausible and particular” in a suit alleging violations of the federal False Claims Act (FCA) for a rehabilitation facility’s alleged presentation for payment to Medicare false claims regarding patient admission services related to sales representatives’ screening narratives.

  • November 17, 2025

    Judge Tosses Yacht Insurers’ Suit Seeking Finding Of No Coverage For Flooding Loss

    KEY WEST, Fla. — In an order docketed Nov. 14, a Florida federal judge dismissed with prejudice a suit filed by insurers of a yacht against the vessel’s owners and the bank listed as the loss payee seeking a declaration that there is no coverage under the policy for a flood-related loss due in part to the insureds’ purported misrepresentations regarding their claim in the policy renewal questionnaire that they had complied with the fire extinguishing equipment warranty.

  • November 13, 2025

    Appeal Of FCA Suit Against Publix Super Markets For Opioid Prescriptions Dismissed

    ATLANTA — The 11th Circuit U.S. Court of Appeals has ordered the dismissal of an appeal filed by an organization comprising two former Publix Super Markets pharmacists that alleges that the grocery chain violated the False Claims Act (FCA) by filling prescriptions for opioids and other controlled substances that it knew were improper after the parties filed a notice of stipulation of dismissal.

  • November 12, 2025

    Judge Denies Transfer, Recusal Motion From Lab Accused Of FCA COVID Testing Fraud

    NEW YORK — A New York federal judge denied a motion by a lab and related parties to transfer venue or for judicial recusal in qui tam suits alleging that they violated the federal False Claims Act (FCA) by submitting false claims to government insurers for reimbursement for COVID-19 testing services, finding that the defendants failed to show the appearance of a personal bias required for recusal and that few federal courts “could have a stronger interest in the resolution of this dispute than the Southern District of New York.”

  • November 10, 2025

    COMMENTARY: Uh-EUO: How Examinations Under Oath Impact Claims

    By Rachel E. Hudgins, Kevin V. Small and Charlotte E. Leszinske

  • November 11, 2025

    Judgment Entered For Novo Nordisk In FCA Dispute Over Hemophilia Drug

    TACOMA, Wash. — A Washington federal court jury found in favor of Novo Nordisk Inc. (NNI) in a qui tam suit accusing it of violating the federal False Claims Act (FCA) and similar state and city laws by allegedly submitting fraudulent claims for payment to government insurers via a “scheme” to persuade patients to seek prescriptions for a Novo Nordisk drug to treat hemophilia rather than a less expensive drug manufactured by another pharmaceutical company.

  • November 06, 2025

    La. Panel Reverses Judgment, Grants Peremptory Exception In Boat Coverage Dispute

    LAKE CHARLES, La. — A Louisiana appellate court on Nov. 5 reversed a lower court’s summary judgment ruling dismissing a bank’s claims against GEICO and granted GEICO’s peremptory exception of no right of action, dismissing the bank’s claims against GEICO with prejudice in the bank’s suit against GEICO seeking to recover damages related to property being stolen from an insured boat, finding that the bank as loss payee lacks a right of action against GEICO.

  • November 05, 2025

    Judge Deems Policy Void For Misrepresentations About Business Operating As A Bar

    SPARTANBURG, S.C. — A South Carolina federal judge on Nov. 4 granted an insurer’s motion for default judgment in its suit seeking rescission of a commercial liability policy for purported misrepresentations about operating the business as a bar, finding that because the misrepresentations “were material to the risk” and the insurer relied on the misrepresentations when issuing the policy, the insurer was entitled to rescind the policy.

  • November 04, 2025

    5th Circuit Affirms Dismissal Of FCA Medicare ‘Fraud’ Suit Against Rehab Facility

    NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on Nov. 3 affirmed a lower court’s ruling dismissing with prejudice a qui tam suit alleging violations of the federal False Claims Act (FCA) for a rehabilitation facility’s alleged presentation for payment to Medicare false claims related to patient admission services, finding that the lower court did not err when dismissing the relator’s complaint as “insufficiently plausible and particular.”

  • November 04, 2025

    Attorneys Seek Payment Of Fees In Insurance Magnate Money Laundering Case

    CHARLOTTE, N.C. —  Legal counsel for insurance magnate Greg Lindberg filed motions and briefs in North Carolina federal court seeking court approval for payment of fees in a case in which 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.