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Mealey's Insurance Fraud

  • July 23, 2025

    Judge Orders Disposition Of Proceeds In Insurance Magnate Money Laundering Case

    CHARLOTTE, N.C. — A North Carolina federal judge on July 22 approved a consent motion filed by a court-appointed special master to dispose of the proceeds from the sale of Irish software companies in a case in which insurance magnate Greg 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.

  • July 23, 2025

    8th Circuit Affirms Ruling Barring Recovery For Fire Damage, Cites Arson Conviction

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on July 22 affirmed a district court ruling granting summary judgment to a bar’s insurer in a dispute over coverage for a fire that destroyed the bar, finding that conduct of one of the bar’s owners that resulted in an arson conviction can be attributed to the entities involved in managing the bar.

  • July 22, 2025

    11th Circuit Affirms $1.75M Judgment For Insured In Bad Faith Storm Damage Row

    ATLANTA — The 11th Circuit U.S. Court of Appeals on July 21 affirmed a $1.75 million judgment for an insured church in its bad faith and breach of contract dispute with its insurer over storm damage coverage, finding “no basis to revisit the evidentiary ruling” in which the lower court excluded evidence of alleged misrepresentation by the insured.

  • July 22, 2025

    Motion To Vacate Denied In GEICO’s PIP Suit Against Pain Management Clinic

    NEWARK, N.J. — A New Jersey federal judge denied GEICO’s motion to vacate an order compelling arbitration in a suit alleging that a pain management clinic and related parties submitted to GEICO for payment fraudulent personal injury protection (PIP) claims, finding that the motion is “deficient” as it is applicable only to final, not interlocutory, orders.

  • July 18, 2025

    Calling Complaint A ‘Mishmash’ Of ‘Schemes,’ Judge Partially Dismisses FCA Suit

    ROANOKE, Va. — A Virginia federal judge partially dismissed a qui tam suit alleging that Virginia behavioral health providers violated the federal False Claims Act (FCA) and similar state law by submitting fraudulent claims for payment to Medicaid, finding that “only one of the eight schemes is described in the second amended complaint with sufficient particularity” that is required to assert claims for fraud.

  • July 17, 2025

    Judge Tosses Suit Seeking Policy Rescission Regarding Coverage For Underlying Case

    HOUSTON — A Texas federal judge dismissed with prejudice an insurer’s suit seeking to rescind a commercial general liability policy issued to an apartment complex and to relieve the insurer of the obligation to indemnify and defend the complex in an underlying sexual assault suit, finding in part that the insurer failed to show its reliance on the purported misrepresentation in a policy renewal application.

  • July 16, 2025

    Judgment Entered For GEICO In Breach Of Contract Suit Over Settlement Agreement

    BROOKLYN, N.Y. —  In a breach of contract suit over purported failure to make payments according to a settlement agreement for an underlying no-fault fraud suit, a New York federal judge adopted a magistrate judge’s report and recommendation, granting GEICO’s motion for default judgment and finding a physician and his related businesses jointly and severally liable for $456,666.65 in damages.

  • July 15, 2025

    Stay Of UIM Arbitration In Coverage Row Denied Absent Evidence Of Staged Accident

    BROOKLYN, N.Y. — A New York state court justice denied an insurer’s petition to permanently stay the uninsured/underinsured/SUM (supplementary uninsured/underinsured motorist) arbitration demanded by a man purportedly injured in an accident while a passenger in an Uber, finding that the insurer failed to provide evidence to establish that the accident was staged.

  • July 14, 2025

    Motion To Set Aside Denied In Allstate RICO Suit Over Hazardous Materials ‘Scheme’

    AUSTIN, Texas — A Texas federal judge adopted a magistrate judge’s report and recommendation and denied 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 “no clear error” in the report and recommendation.

  • July 10, 2025

    1st Circuit Issues Errata After Affirming Dismissal Of FCA Suit Against Clinics

    BOSTON — The First Circuit U.S. Court of Appeals on July 9 issued an errata to correct an error in its prior opinion affirming a lower court’s rulings dismissing and denying a motion to amend a relator’s qui tam suit against dialysis clinics alleging violations of the federal False Claims Act (FCA) related to a purported fraudulent kickback scheme.

  • July 10, 2025

    Summary Judgment Partially Granted For Insurer In Dispute Over Fire Coverage

    SEATTLE — A Washington federal judge partially granted summary judgment for an insurer in a coverage dispute related to underlying litigation regarding an apartment complex fire, finding that the insured made material omissions in failing to keep the insurer updated on the insured’s status as a party in the underlying litigation.

  • July 08, 2025

    Judge Imposes Penalties Of $542M Against CVS Subsidiary In FCA Row With Government

    NEW YORK — After a jury delivered a verdict in favor of the U.S. government in a federal False Claims Act (FCA) suit alleging that CVS Health Corp. (CVSHC) and its subsidiary, Omnicare Inc., submitted fraudulent claims for payment to the government, a New York federal judge on July 7 imposed penalties of $542 million on Omnicare, finding that the penalties requested by the government do not exceed “the Eighth Amendment's guardrails.”

  • July 08, 2025

    Magistrate Won’t Dismiss Vermont False Claims Act Suit Over Wrongful Termination

    BURLINGTON, Vt.  — A Vermont federal magistrate judge denied dismissal of a suit alleging violations of the Vermont False Claims Act (VFCA) for a company’s purported wrongful termination of a physician/chief medical officer of operations for the Vermont Department of Corrections, finding that the physician does not need to “plead the submission of a fraudulent claim” to show that he engaged in protected activity under the act.

  • July 07, 2025

    11th Circuit ‘Largely’ Affirms Dismissal Of FCA Suit Against Ga. Family Practices

    ATLANTA — The 11th Circuit U.S. Court of Appeals “largely” affirmed a lower court’s dismissal of a qui tam suit alleging violations of the federal False Claims Act (FCA) and similar Georgia state law regarding a family practitioner and his practices allegedly submitting false claims to Medicare and Medicaid through various “schemes,” finding that the allegations sufficed for the kickback and self-referral schemes but that the lower court correctly dismissed the other claims.

  • July 03, 2025

    Report Advising Sanctions For Lost Text Messages Accepted In Insurance Coverage Row

    MINNEAPOLIS — A Minnesota federal judge accepted a magistrate judge’s report and recommendation advising granting sanctions only as to an adverse inference instruction related to the purported destruction of text messages by an insured, a Minneapolis event center, in the insurer’s suit seeking a declaration that it does not need to pay an appraisal award of $986,436 related to business income loss the insurer says was based upon “concealed and misrepresented material facts and circumstances willfully and with intent to defraud.”

  • July 02, 2025

    DOJ, HHS Announce FCA Working Group Partnership ‘To Combat’ Health Care Fraud

    WASHINGTON, D.C. — The U.S. Department of Justice (DOJ) on July 2 issued a press release announcing a partnership with the U.S. Department of Health and Human Services (HHS) to form a False Claims Act (FCA) Working Group “to combat” health care fraud.

  • July 02, 2025

    Yacht Insurers Sue Owners, Seeking Finding Of No Coverage For Flooding Incident

    KEY WEST, Fla. — Insurers of a yacht sued the vessel’s owners and the bank listed as the loss payee in a Florida federal court, 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.

  • July 02, 2025

    New York Panel Affirms Judgment Rescinding Insurance Policy In Coverage Row

    NEW YORK — A New York state appellate court affirmed a lower court order granting an insurer’s motion for summary judgment and rescinding an insurance policy for purported misrepresentations in the policy application and finding that the insurer has no duty to defend or indemnify in an underlying personal injury suit, finding that the additional insured failed to show that the insurer’s motion for summary judgment should have been denied pursuant to a waiver defense.

  • July 01, 2025

    Judgment Entered For Insurer In Driving Record ‘Misrepresentation’ Dispute

    RALEIGH, N.C. — A North Carolina federal judge on June 30 granted a boat insurer’s motion for judgment on the pleadings, construing it as a summary judgment motion in a coverage dispute, finding that the insurer is entitled to summary judgment due to a policy exclusion and is not bound by the terms of the policy due to the insured’s “material misrepresentation” regarding his driving record.

  • July 01, 2025

    1st Circuit Affirms Dismissal Of FCA Suit Against Clinics Alleging Kickbacks

    BOSTON — The First Circuit U.S. Court of Appeals affirmed a lower court’s rulings dismissing and denying a motion to amend a relator’s qui tam suit against dialysis clinics alleging violations of the federal False Claims Act (FCA) related to a purported fraudulent kickback scheme, finding that the relator failed to meet the heightened pleading standards required by the Federal Rules of Civil Procedure and that the lower court did not abuse its discretion in denying leave to amend.

  • June 26, 2025

    Texas Federal Judge Partly Grants Judgment In State Farm’s RICO Insurance Fraud Row

    SAN ANTONIO — A Texas federal judge partially granted a physician and his practice’s summary judgment motion in State Farm’s Racketeer Influenced and Corrupt Organizations Act (RICO) fraud suit alleging that the physician submitted fraudulent medical bills inflating the severity of patients’ injuries for medically unnecessary injections, finding that summary judgment is warranted for the RICO claim allegation based on “fabricated treatment or patients.”

  • June 23, 2025

    N.J. Panel Vacates Order Denying Allstate Motion To Disqualify Law Firm In PIP Row

    TRENTON, N.J.  — A New Jersey appellate court vacated a lower court order denying Allstate’s motion to disqualify a law firm representing approximately 35 of the 42 defendants in a suit over an alleged personal injury protection (PIP) fraud “scheme,” finding that the lower court erred in its determination that there was no risk for conflict among the defendants represented by the firm.

  • June 20, 2025

    Federal Judge Tosses Reinsurers RICO ‘Fake Accident’ Suit Against Law Firm, Agent

    BROOKLYN, N.Y. — A New York federal judge on June 19 dismissed without prejudice a Racketeer Influenced and Corrupt Organizations Act (RICO) suit against a law firm and its agent accused of a “scheme” to defraud a reinsurer and a related party by staging construction-related workers’ compensation accidents, finding that the claims fail for lack of pleading “direct injuries.”

  • June 20, 2025

    Parties File Stipulation Of Dismissal In FCA Suit Over ‘Substandard’ Care

    PHILADELPHIA — Nursing homes and related entities sued by the U.S. government over alleged violations of the False Claims Act (FCA) related to purportedly providing “grossly substandard nursing home services to Medicare and Medicaid beneficiaries” filed, together with the government, a joint stipulation of dismissal with prejudice in Pennsylvania federal court.

  • June 19, 2025

    Judge Tosses FCA Suit, Denies Motion To Amend In Case Alleging Medicare Fraud

    WASHINGTON, D.C.  — A District of Columbia federal judge denied relators’ motion to amend and dismissed their qui tam suit alleging that a hospital and related parties violated the federal False Claims Act (FCA) by submitting claims to Medicare and Medicaid that allegedly falsely attested compliance with participation in those programs, finding that the relators failed to state a claim for relief and that amendment would be futile.