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Mealey's Insurance Fraud

  • 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.

  • November 04, 2025

    N.J. Panel Affirms Judgment For Insurer In Fire Coverage Dispute With Homeowners

    TRENTON, N.J. — A New Jersey appellate court affirmed a lower court’s ruling granting summary judgment to an insurer in homeowners’ breach of contract and bad faith suit over the insurer’s purported failure to cover fire damage, ruling that the lower court did not err in finding that policy rescission was appropriate because the homeowners did not comply with the policy provision requiring that they “customarily occupy” the insured premises.

  • October 30, 2025

    Motion To Compel Denied In RICO Insurance Fraud Suit Against Physician, Practices

    DETROIT — A Michigan federal judge on Oct. 29 denied a motion to compel discovery by a physician and medical practices in a suit accusing them of violating the Racketeer Influenced and Corrupt Organizations Act (RICO) and Michigan’s No-Fault Act by participating in a scheme to defraud Allstate by submitting fraudulent bills for treatments that were not medically necessary, finding that Allstate correctly showed that the documents at issue were privileged.

  • October 28, 2025

    Motion To Vacate Granted In Employee Fraud Suit With Jury Award Of Over $2.4M

    SANTA ANA, Calif. — After the parties filed a joint stipulation to vacate upon reaching a confidential settlement, a California federal judge on Oct. 27 issued an order vacating a prior final judgment after a jury awarded an insurer more than $2.4 million in damages for fraud committed by an insured employer and his California limited liability company regarding misrepresenting the employer’s nonagenarian father as an employee insured under the company’s group health plan.

  • October 28, 2025

    Magistrate Grants Motion To Compel Discovery In ‘Upcoding’ Insurance Fraud Suit

    KNOXVILLE, Tenn. — A Tennessee federal magistrate judge granted in part a motion to compel discovery in a suit filed by UnitedHealthcare Insurance Co. and related entities alleging that medical staffing companies were “upcoding” claims, resulting in millions of dollars in overpayment, finding that the staffing companies failed to show the “disproportional” nature of the discovery request for production (RFP) related to financial reports regarding the impact of coding on profits.

  • October 27, 2025

    Motion To Compel Granted In RICO Suit Over Fraudulent No-Fault Claims

    BROOKLYN, N.Y. — A New York federal magistrate judge on Oct. 23 granted an insurer’s motion to compel a response to a subpoena issued to a nonparty owned by one of the individual defendants in a Racketeer Influenced and Corrupt Organizations Act (RICO) suit alleging that individuals, medical providers and physicians participated in a multimillion-dollar fraudulent scheme to bill the insurer for medically unnecessary services, finding that the documents sought through the subpoena are relevant to the suit.

  • October 24, 2025

    Pennsylvania Panel Affirms Ruling In Unemployment Compensation Fraud Case

    HARRISBURG, Pa. — The Pennsylvania Commonwealth Court on Oct. 23 affirmed a ruling by the Pennsylvania Unemployment Compensation Board of Review that assessed a fraud overpayment in Pandemic Unemployment Assistance (PUA) benefits and a Federal Pandemic Unemployment Compensation (FPUC) fraud overpayment against a claimant who filed for benefits in both Pennsylvania and Massachusetts, finding that the board’s determination regarding the claimant’s intention when filing “for PUA benefits in Pennsylvania was supported by substantial evidence and cannot be set aside.”

  • October 24, 2025

    2nd Circuit Won’t Rehear FCA Medicare Fraud Dispute With Whistleblower Physician

    NEW YORK — The Second Circuit U.S. Court of Appeals denied a whistleblower physician’s petition for panel or en banc rehearing of the court’s ruling affirming a district court order denying his motion to reopen a federal and state false claims act violations suit alleging fraudulent Medicare and Medicaid billing by a health system.

  • October 21, 2025

    After Notice Of Settlement, Judge Tosses Hurricane Coverage Row Alleging Fraud

    NEW ORLEANS — After being advised that the parties agreed to settle, a Louisiana federal judge dismissed a dispute over insurance coverage for hurricane damage and purported fraud regarding the insured’s alleged material misrepresentations related to property renovations.

  • October 20, 2025

    N.Y. Justice Grants Insurer’s Default Bid In No-Fault Row Over ‘Alleged Injuries’

    NEW YORK — A New York state justice granted default judgment to an insurer as to certain specified defendants in a dispute with multiple medical providers and two pedestrians purportedly injured in an auto accident, finding in part that some of the defendants failed to provide good cause for not timely answering the complaint or appearing in court.

  • October 17, 2025

    Judge Denies Pain Management Clinic’s Reconsideration Bid In GEICO’s PIP Suit

    NEWARK, N.J. — A New Jersey federal judge denied a motion by a pain management clinic and related party for reconsideration of a prior ruling that dismissed without prejudice a state fraud claim against them in a suit alleging that the defendants submitted to GEICO for payment fraudulent personal injury protection (PIP) claims, finding that the clinic and related party “are not entitled to reconsideration” because they failed to show that the court “committed legal error.”

  • October 15, 2025

    Ohio Panel Affirms Judgment For Insurer In Fire Coverage Dispute With Mortgagee

    TOLEDO, Ohio — An Ohio appellate court on Oct. 14 affirmed a trial court’s judgment for an insurer in a dispute between the insurer and a mortgagee over the debt owed to it after a fire damaged property for which it held a mortgage, finding that the trial court did not err in dismissing the suit because the mortgagee failed to provide evidence establishing damage and repair costs of the mortgaged property and whether it was a total loss.

  • October 15, 2025

    Judge Tosses FCA Fraudulent Billing Suit, Finds First-To-File Bar Applies

    BALTIMORE — A Maryland federal judge granted a motion to dismiss filed by health care providers and a skilled nursing facility (SNF) in a qui tam suit alleging that they violated the False Claims Act (FCA) by purportedly billing Medicare and Medicaid for unnecessary services, finding that the first-to-file rule applies and bars the claims against them.

  • October 14, 2025

    Insurance Holding Company Sues Captive Operator, Seeks Preliminary Injunction

    JACKSONVILLE, Fla. — An insurance holding company seeks a preliminary injunction in a Florida federal court against a captive operator and its associated entities it accuses of counterfeiting its name and trademarks to sell fake commercial insurance policies through two purported captive programs; in a concurrent complaint, the insurance holding company alleges direct, contributory and vicarious trademark infringement under the Lanham Act and unfair competition under several state common laws and seeks declaratory and injunctive relief.

  • October 13, 2025

    Judgment Granted For Insurer In Dispute Over $500K Life Policy For Homicide Victim

    WILMINGTON, Del. — A Delaware federal judge on Oct. 10 granted summary judgment for an insurer in a life insurance policy beneficiary’s breach of contract suit against the insurer for failure to pay out the proceeds of a $500,000 life insurance policy after the insured’s murder, finding that the insurer “successfully” rescinded the policy.

  • October 13, 2025

    Finding ‘No Coverage,’ Florida Panel Affirms Judgment For Insurer In Collision Row

    MIAMI — A Florida appellate court affirmed a lower court’s judgment for an insurer in a dispute over coverage for injuries its insured purportedly sustained in an auto accident, finding that there was “no coverage” because evidence in the lower court showed “that the Insured made a material misrepresentation” regarding his address on his policy application.

  • October 09, 2025

    Justice Grants Default As To Individual Defendants In No-Fault Dispute With Hertz

    NEW YORK — A New York state court justice granted in part default judgment to the owner and insurer of a vehicle involved in an accident, Hertz Vehicles LLC, in its suit against multiple medical providers, pharmacies and individuals who allegedly were treated for injuries sustained in the accident by the providers whose no-fault claims Hertz denied, finding that Hertz has shown “that it has no duty to pay” the claims related to the alleged accident and that the individual defendants were properly served.