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Mealey's Insurance Fraud

  • 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.

  • September 30, 2025

    Motions For Judgment Denied In Coverage Dispute With Burger King Restaurants Owner

    BIRMINGHAM, Ala. — An Alabama federal judge denied summary judgment motions filed by a business insurer and its insured, a company that owns multiple Burger King restaurants, in a coverage dispute over fire damage to a Hoover, Ala., Burger King, finding that summary judgment is denied to the company because it failed to address whether the insurer’s decision not to pay the claim is a breach of the insurance contract.

  • September 26, 2025

    6th Circuit Affirms Ruling In Insurance Row Involving Chris Brown Recording Studio

    CINCINNATI  — The Sixth Circuit U.S. Court of Appeals on Sept. 25 affirmed a lower court ruling requiring the insurer of a recording studio owned by musician Chris Brown to pay out the majority of a $2.5 million jury verdict to a co-defendant and lessee of the studio after Brown was previously found liable for submitting a fraudulent insurance claim for burglary and fire at the studio, finding in part that the insurer may not challenge the award going to the lessee pursuant to arguments the insurer could have brought previously.

  • September 24, 2025

    Judge Tosses FCA Suit Related To Drug Patent Pursuant To Public Disclosure Bar

    BOSTON — A Massachusetts federal judge on Sept. 23 dismissed a qui tam relator’s suit alleging violations of the federal False Claims Act (FCA) and related state laws regarding pharmaceutical companies’ purported fraudulently obtained patents for the drug Xyrem resulting in government health insurers reimbursing Xyrem prescriptions “at inflated prices,” finding that facts in the complaint were previously disclosed and that the public disclosure bar applies.

  • September 23, 2025

    N.J. Panel Affirms Denial Of Insurer’s Motion To Disqualify Insured’s Attorney

    TRENTON, N.J. —A New Jersey appeals panel on Sept. 22 affirmed a lower court’s denial of an insurer’s motion to disqualify an insured’s attorney in a coverage dispute over an $772,500 theft claim, rejecting the insurer’s argument that the attorney was a necessary witness for trial and also agreeing with the lower court’s decision to quash the insurer’s subpoena served on the attorney and issue a protective order barring the insurer from seeking the attorney’s disqualification.

  • September 23, 2025

    Michigan Panel Affirms Summary Disposition For Insurer In PIP Coverage Dispute

    DETROIT — A Michigan appellate court affirmed a lower court order granting summary disposition to an auto insurer in a personal injury protection (PIP) coverage dispute with its insured, finding that the lower court did not err because the issuance of the policy constituted an injury resulting from material misrepresentations and without the policy being issued, the insurer “would not have been liable for the PIP benefits.”

  • September 22, 2025

    Judgment Granted For Insurer In Dispute Over Rescission, ‘Misrepresentations’

    PORTLAND, Maine — A Maine federal judge on Sept. 19 granted summary judgment to an auto insurer sued by its insured alleging breach of contract for the insurer’s failure to cover his auto accident and for rescission of his policy, finding no dispute of material fact related to any of the insured’s claims.

  • September 18, 2025

    2nd Circuit Affirms Ruling Denying Bid To Reopen FCA Suit Based On New Evidence

    NEW YORK — The Second Circuit U.S. Court of Appeals on Sept. 17 affirmed a district court order denying a whistleblower physician’s motion to reopen a federal and state false claims act violations suit alleging fraudulent Medicare and Medicaid billing by a health system, finding that the physician failed to show that the health system’s failure to produce the purported newly discovered evidence of a single email was intentional.

  • September 18, 2025

    FCA Retaliation Suit Against Nonprofit Tossed Absent Notice Of Protected Activity

    WASHINGTON, D.C. — A District of Columbia federal judge dismissed without prejudice a former employee’s suit alleging that the nonprofit where she worked violated the retaliation provisions of the federal False Claims Act (FCA) by allegedly terminating her employment in retaliation for her complaints about the organization’s purported inaccurate backdating documents to obtain payments from federal health insurers, finding that the woman failed to establish that her former employer knew that she was engaged in protected activity.

  • September 17, 2025

    RICO, Fraud Claims Dismissed In Travelers’ No-Fault Suit Against DME Provider

    BROOKLYN, N.Y. — A New York federal judge dismissed Racketeer Influenced and Corrupt Organizations Act (RICO) claims against all defendants and a common-law fraud claim against individual defendants in a suit filed by subsidiaries of Travelers Companies Inc. asserting that a durable medical equipment (DME) manufacturer and related individuals orchestrated a scheme to defraud Travelers by submitting for reimbursement no-fault and workers’ compensation claims that were ineligible for reimbursement, finding in part that Travelers failed to allege that the individuals participated in the purported fraud.

  • September 17, 2025

    Panel Rehearing Bid Fails In LTD Benefits Dispute Involving Jury Verdict

    ATLANTA — In a per curiam order issued without explanation in a dispute where a federal jury sided with a long-term disability (LTD) insurer, the 11th Circuit U.S. Court of Appeals denied a petition for panel rehearing, letting stand its ruling vacating a judgment of nearly $450,000 for the insurer on its unjust enrichment claim but upholding dismissal of a breach of contract counterclaim.

  • September 16, 2025

    7th Circuit Affirms $193M Medicare Drug Rebate False Claims Judgment Against Lilly

    CHICAGO — The Seventh Circuit U.S. Court of Appeals affirmed a final judgment of $193 million against Eli Lilly & Co. stemming from a False Claims Act jury verdict for reporting falsely deflated drug prices to the government.

  • September 15, 2025

    Magistrate Advises Entering Default, Awarding Over $481K In Insurance Fraud Suit

    BROOKLYN, N.Y. — A New York federal magistrate judge on Sept. 12 issued a report and recommendation, advising granting GEICO’s motion for default judgment against a physician and his related entities and entering a judgment of $481,233.13 in compensatory damages against them in GEICO’s suit alleging that multiple providers participated in a scheme to submit fraudulent charges for medically unnecessary services under New York’s no-fault insurance law.

  • September 15, 2025

    Summary Judgment Denied For Insurer In Fabric Water Damage Coverage Dispute

    BALTIMORE — A Maryland federal judge denied summary judgment to an insurer in a breach of contract and bad faith suit filed against it by its insured, a “high-end” fabric retailer seeking coverage for water damage, finding that “summary judgment is not appropriate” in part because of remaining questions as to whether the insured voided the policy pursuant to a fraud provision regarding alleged “bogus” estimates of damage.

  • September 11, 2025

    DOJ Subpoena Quashed In Gender Affirming Care Dispute Over Possible FCA Violations

    BOSTON — A Massachusetts federal judge denied a motion to seal but granted a motion to quash filed by Boston Children’s Hospital (BCH) regarding a U.S. Department of Justice (DOJ) subpoena seeking information on the hospital’s provision of gender affirming care (GAC), finding that the hospital failed to show “why sealing is required” but that the government failed to “show proper purpose” in its subpoena that was issued the same day as a DOJ civil division memorandum outlining investigations into possible violations of the False Claims Act (FCA) for billing the government for GAC services that are allegedly impermissible.

  • September 10, 2025

    Shepard's Analysis Of FCA Suit Finding Qui Tam Provisions Unconstitutional

    As of Sept. 9, 26 federal courts have referenced in their opinions United States ex rel. Clarissa Zafirov v. Physician Partners, LLC, et al., No. 19-1236, M.D. Fla., 2024 U.S. Dist. LEXIS 176626, a ruling currently on appeal in the 11th Circuit U.S. Court of Appeals and tentatively scheduled for oral argument during the week of Dec. 8.

  • September 09, 2025

    Motions To Compel Discovery Granted In Part In Hurricane Coverage Dispute

    NEW ORLEANS — A Louisiana federal magistrate judge on Sept. 8 granted in part and denied in part a homeowners insurer’s motions to compel production of documents by an appraiser and his firm in a Hurricane Ida coverage dispute, finding that the appraiser’s contracts for the past 10 years are “relevant.”