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Mealey's Insurance Fraud

  • 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.

  • October 08, 2025

    Michigan Panel Reverses Judgment For Allstate In Car Accident PIP Coverage Dispute

    DETROIT — Calling a lower court’s order “erroneous,” a Michigan appellate court reversed and remanded the order granting summary disposition in favor of Allstate in an auto accident personal injury protection (PIP) coverage dispute with medical providers, finding that the lower court erred in its judgment because the record did not show that the injured woman seeking PIP benefits “made fraudulent statements during the application process.”

  • October 08, 2025

    Motion To Disclose Policyholder Data Granted In Insurance Conspiracy Case

    CHARLOTTE, N.C. — A North Carolina federal magistrate judge granted a court-appointed special master’s consent motion to compel disclosure of policyholder data and for a protective order in a case in which insurance magnate Greg Lindberg pleaded guilty to money laundering conspiracy and conspiracy for his $2 billion scheme to defraud insurers and policyholders by funneling money through his extensive global network of insurance companies.  Lindberg was also convicted on retrial in a related criminal proceeding.

  • October 07, 2025

    Status Conference Canceled In Liberty Mutual Fraud Suit Against Pharmacies, Owners

    CENTRAL ISLIP, N.Y. — After parties stipulated to dismissal, a New York federal magistrate judge in a docket-only order canceled a status conference in Liberty Mutual’s suit against pharmacies and their owners, alleging 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.

  • October 06, 2025

    U.S. Supreme Court Denies Cert In Dispute Over Insurance Fraud Judgment

    WASHINGTON, D.C. — The U.S. Supreme Court on Oct. 6 denied 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.

  • October 03, 2025

    Judge Tosses United Healthcare Fraud Suit Against Distributor Of Oncology Drugs

    MINNEAPOLIS — A Minnesota federal judge on Oct. 2 dismissed with prejudice a suit filed by United Healthcare Services Inc. (UHS), a subsidiary of UnitedHealth Group Inc., 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 in part that the alleged fraudulent statements lack specificity to show statutory or common-law fraud.

  • October 02, 2025

    N.Y. Federal Judge Compels Arbitration In Escrow Dispute, Denies Dismissal Bid

    ALBANY, N.Y. — A New York federal judge compelled arbitration among a borrower, an insurer, the insurer’s CEO and a liaison of the insurer, holding that the borrower, seeking to recover a $1 million escrow deposit tied to a failed $5 million loan, brought claims under an insurance policy containing an arbitration clause, thereby binding the insurer, CEO and liaison to arbitration.

  • October 02, 2025

    Ohio Panel Reverses Judgment For Insurer In Coverage Dispute Over Auto Accident

    YOUNGSTOWN, Ohio — In consolidated appeals filed by four people injured in an auto accident, an Ohio appellate court on Oct. 1 reversed and remanded a lower court’s judgment in favor of an auto insurer in a dispute over coverage for an auto accident that injured the four bystanders, finding that the trial court erred in not making a determination as to whether the vehicle responsible for the accident was stolen.

  • October 02, 2025

    Judgment Denied In Hurricane Coverage Row Over Renovation ‘Misrepresentations’

    NEW ORLEANS — A Louisiana federal judge denied summary judgment to an insurer in a dispute over insurance coverage for hurricane damage and purported fraud regarding the insured’s alleged material misrepresentations related to property renovations, finding that the court cannot determine “based on the record before it” whether the insured intended to deceive when making the purported misrepresentations.

  • October 02, 2025

    Relator Appeals Dismissal Of FCA Suit Against Publix Super Markets

    TAMPA, Fla. — An organization comprising two former Publix Super Markets pharmacists that alleges that the grocery chain violated the False Claims Act (FCA) by knowingly filling prescriptions for opioids and other controlled substances that it knew were improper is appealing to the 11th Circuit U.S. Court of Appeals a decision by a Florida federal judge that dismissed its second amended complaint with prejudice.

  • October 01, 2025

    3rd Circuit Remands For Restitution Assessment In Medicare Fraud Judgment Row

    PHILADELPHIA — The Third Circuit U.S. Court of Appeals affirmed in part, vacated in part and remanded a district court’s ruling that restitution obligations were not satisfied in a woman’s appeal related to court-ordered restitution for her role in a Medicare fraud “scheme,” finding that though the lower court “reasonably interpreted” the restitution judgment, it abused its discretion regarding how to count restitution payments.

  • September 30, 2025

    Default Judgment Granted In Dispute Over Marine Policy Coverage For Injured Person

    MIAMI — A Florida federal judge granted final default judgment to insurers in a breach of the duty of uberrimae fidei suit against their insured, a company that owns a yacht on which a former employee was purportedly injured, finding that the insurers satisfied the requirements for default judgment and that the policy is void for misrepresentations the insured made regarding not employing persons to work onboard the yacht.