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Preview: LexisNexis® Mealey's™ Insurance Fraud Legal News

LexisNexis® Mealey's™ Insurance Fraud Legal News



Headline Insurance Fraud Legal News from LexisNexis®



 



4th Circuit: Judge Properly Addressed Materiality Of Couple's Misrepresentations
RICHMOND, Va. - A Fourth Circuit U.S. Court of Appeals panel on Oct. 30 affirmed a federal judge in Virginia's decisions finding a couple guilty of conspiring to commit health care fraud and denying their post-trial motions for acquittal, holding that the judge properly addressed whether misrepresentations the defendants made to insurers were material (United States of America v. Beth Palin, et al., Nos. 16-4522, 16-4540, 4th Cir., 2017 U.S. App. LEXIS 21596).



Federal Judge Finds Oregon Waived Sovereign Immunity From Coverage Case
PORTLAND, Ore. - After finding that the state of Oregon waived its right to sovereign immunity in an action brought by an insurer that seeks to have an environmental policy voided based on alleged misrepresentations made by the insureds, an Oregon federal judge on Oct. 17 adopted a magistrate judge's recommendation to grant the state's motion to intervene (United Specialty Insurance Co. v. Clay Jonak, et al., No. 3:17-cv-00330, D. Ore., 2017 U.S. Dist. LEXIS 172150).



Fabricated Authorization Letter Constituted Fraud, Pennsylvania Appeals Court Finds
PITTSBURGH - A woman was properly convicted for insurance fraud, forgery and theft of property, a Pennsylvania appeals panel ruled Nov. 7, finding that the woman's presentation of a fabricated authorization letter for dental work constituted an attempt to defraud her insurance company (Commonwealth of Pennsylvania v. Amy Lee Palmer, No. 1039 WDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4117).



Intervenor's Request To Amend Pleadings Against Insurer Untimely, Judge Says
GREENBELT, Md. - An intervening party in an insurance company's lawsuit accusing an insured of making material misrepresentations on a policy application cannot amend its pleadings to change admissions and add counterclaims, a federal judge in Maryland ruled Nov. 13, finding that the request was untimely (CX Insurance Company v. Benjamin L. Kirson, No. 15-cv-3132, D. Md., 2017 U.S. Dist. LEXIS 187164).



Evidence Supported Convictions For Fraud, Kickback Charges, 5th Circuit Says
NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Nov. 7 upheld convictions of a man and his son who were accused of health care fraud and paying kickbacks to obtain business for their partial hospitalization programs (PHPs), ruling that evidence presented by the government was sufficient to support the jury's verdict (United States of America v. Earnest Gibson III, et al., No. 15-20323, 5th Cir., 2017 U.S. Dist. LEXIS 22261).



Woman Convicted For Role In $3.2M Kickback Scheme To Provide Medical Equipment
NEW ORLEANS - A federal judge in Louisiana on Nov. 8 found a woman guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks, two counts of health care fraud and five counts of accepting kickbacks for her role in a $3.2 million scheme that involved providing durable medical equipment to Medicare beneficiaries that was medically unnecessary (United States of America v. Tracy Richardson Brown, et al., No. 13-cr-243, E.D. La.).



Doctor Pleads Guilty To Opioid Health Care Fraud, Taking Kickbacks From Insys
PROVIDENCE, R.I. - A Rhode Island doctor on Oct. 25 pleaded guilty to health care fraud and taking kickbacks for prescribing the opioid Subsys to unqualified patients (United States of America v. Jerrold N. Rosenberg, No. 17-9, D. R.I.).



Health Care Fraud Defendant Ordered To Pay $847,016 In Restitution
BOISE, Idaho - A federal judge in Idaho on Oct. 27 ordered a dentist to pay $847,016 in restitution and forfeit $139,769.80 after pleading guilty to 24 counts of health care fraud (United States of America v. Cherie Renee Dillon, No. 16-cr-0037, D. Idaho, 2017 U.S. Dist. LEXIS 178810).



Pennsylvania Panel Upholds Woman's Conviction, Sentence For Insurance Fraud
PHILADELPHIA - A Pennsylvania appeals panel on Nov. 7 overruled a woman's argument that evidence presented during her insurance fraud trial did not support her conviction, holding that the state sufficiently showed an intent to defraud through her false statements to a state trooper during the investigation of a car fire (Commonwealth of Pennsylvania v. Ruth E. Gettel, No. 533 MDA 2017, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4101).



Pennsylvania Panel Upholds Insurance Fraud Sentence, Allows Counsel To Withdraw
PHILADELPHIA - A Pennsylvania Superior Court panel on Oct. 27 affirmed a man's sentence of nine to 23 months in prison for insurance fraud and receiving stolen goods and allowed the man's attorney to withdraw from the case (Commonwealth of Pennsylvania v. Tracy Martin, No. 3789 EDA 2016, Pa. Super., 2017 Pa. Super. Unpub. LEXIS 4013).



Appeals Court: Judge Erred When Resentencing Woman For Insurance Fraud
DAYTON, Ohio - An Ohio appeals panel on Oct. 20 overturned a trial court judge's ruling that resentenced a woman on one count of insurance fraud, holding that the judge should have found that the sentence would run concurrently with, rather than consecutive to, other charges (State of Ohio v. Eva Christian, No. 27236, Ohio App., 2nd Dist., 2017 Ohio App. LEXIS 4641).



State Farm Can Pursue Trade Practices Claims Over Billing Scheme, Judge Says
MIAMI - State Farm Mutual Automobile Insurance Co. can pursue claims under the Florida Deceptive and Unfair Trade Practices Act (FDUTPA) against medical facilities accused of participating in a fraudulent billing scheme that caused the insurer to incur damages exceeding $3.8 million, a federal judge in Florida ruled Sept. 25, ruling that State Farm sufficiently stated claims for relief under the act (State Farm Mutual Automobile Insurance Company v. Performance Orthopaedics & Neurosurgery, LLC, et al., No. 17-cv-20028-KMM, S.D. Fla., 2017 U.S. Dist. LEXIS 156284).



Judge: Antagonistic Defenses Do Not Warrant Severing Insurance Fraud Defendants
NEW YORK - A federal judge in New York on Nov. 3 denied motions filed by two doctors seeking to sever their claims from a criminal insurance fraud indictment, finding that the defendants' antagonistic defenses and the possibility of prejudicial spillover did not warrant severance (United States of America v. Asim Hameedi, et al., No. 17 Cr. 137, S.D. N.Y., 2017 U.S. Dist. LEXIS 182790).



Judge Adopts Recommendation To Deny Motion To Dismiss Fraud Indictment
MINNEAPOLIS - A federal judge in Minnesota on Oct. 25 adopted a magistrate judge's Sept. 8 recommendation to deny an insurance fraud defendant's motion to dismiss a two-count indictment accusing him of submitting false bills from his chiropractic firm to insurers (United States of America v. Timothy Wayne Guthman, No. 17-67, D. Minn., 2017 U.S. Dist. LEXIS 177656).



Doctor Sentenced To 15 Years, Ordered To Pay $9.1 M For Fraud Scheme
DETROIT - A doctor was sentenced to 15 years in prison and ordered to pay $9.1 million in restitution by a federal judge in Michigan on Nov. 8 after being found guilty for his role in a $26 million health care fraud scheme that involved billing Medicare for nerve block injections that were never provided (United States of America v. John Trotter II, et al., No. 14cr20273, E.D. Mich.).



2 California Residents Sentenced Over $38M Insurance Fraud Scheme
NEW ORLEANS - Two California residents who owned and operated a medical equipment store were sentenced by a federal judge in Louisiana on Nov. 2 for their roles in a $38 million fraud scheme centering around the distribution of talking glucose meters that were not medically needed and were often not even requested (United States of America v. Geoffrey Ricketts, et al., No. 15cr153, E.D. La.).



Judge Refuses To Allow Insurance Fraud Defendant To Withdraw Guilty Plea
CLEVELAND - A chiropractor who pleaded guilty to conspiracy to commit health care fraud, health care fraud, conspiracy to commit money laundering and wire fraud cannot withdraw his plea, a federal judge in Ohio ruled Oct. 19, finding that the request was untimely (United States of America v. John Fortuna, No. 14cr447, N.D. Ohio, 2017 U.S. Dist. LEXIS 173297).



Doctor Sentenced To 5 Years In Prison For Fraud, Money-Laundering Scheme
MIAMI - A federal judge in Florida on Nov. 8 sentenced a doctor to five years in prison and ordered him to pay $2.1 million in restitution for his role in an health care fraud and money-laundering scheme that involved the filing of fraudulent insurance claim forms and defrauding health care benefit programs (United States of America v. Kenneth Chatman, et al., No. 17cr80013, S.D. Fla.).



Parties Announce $5M Settlement In False Claims Act Lawsuit Against Nursing Home
HOUSTON - The United States of America, the state of Texas, a whistleblower, a nursing home and its parent company on Oct. 6 filed a joint stipulation of dismissal of claims alleging that the nursing home conducted a scheme to bill Medicare and Texas Medicaid to obtain payment for services that were never provided or were so deficient that they harmed patients and were "essentially worthless" (United States and Texas ex rel. Susan Anthony v. Health Services Management, Inc., et al., No. 15-2291, S.D. Texas).



3rd Circuit Affirms Dismissal Of Insurer's Fraud Suit Against Attorneys, Firm
PHILADELPHIA - A federal judge in Pennsylvania did not err when dismissing an insurance company's claims that two attorneys and their law firm conspired to submit two fraudulent insurance claims for damage at a church, a Third Circuit U.S. Court of Appeals ruled Sept. 15, finding that the insurer's claims were barred by judicial privilege (Church Mutual Insurance Company v. Alliance Adjustment Group, et al., No. 16-3302, 3rd Cir., 2017 U.S. App. LEXIS 17864).



3rd Circuit: Commerce Clause Criminalizes Arson Of Rental Property For Benefits
PHILADELPHIA - A woman cannot seek to rescind her guilty plea on one count of malicious destruction of property by fire, the Third Circuit U.S. Court of Appeals ruled Oct. 12, finding that the commerce clause of the U.S. Constitution criminalizes the destruction of the rental property she set fire to in order to submit a fraudulent claim for insurance proceeds (United States of America v. Andrea Forsythe, No. 17-1019, 3rd Cir., 2017 U.S. App. LEXIS 19941).



Government Can Present Evidence On Other Fires, Insurance Claims, Judge Says
RICHMOND, Va. - The federal government can present evidence regarding allegations that a woman accused of conspiracy to commit wire fraud, use of fire to commit a federal felony and making false statements was involved in other fires that resulted in her filing insurance claims, a federal judge in Virginia ruled Oct. 13, holding that the evidence is admissible under Federal Rules of Evidence 401, 403 and 404(b) (United States of America v. Eugenia Fleming, et al., No. 17-cr-29, E.D. Va., 2017 U.S. Dist. LEXIS 170046).



Insurer's Lawsuit Accusing Law Firm of Fraud Dismissed By Judge
NEWARK, N.J. - A federal judge in New Jersey on Oct. 16 granted a motion to dismiss filed by estates named as defendants in an insurer's declaratory judgment lawsuit accusing a law firm of making misrepresentations on its Lawyers Professional Liability Policy application, finding that an underlying action in state court filed by the estates is a more appropriate forum for the insurer's allegations (Markel Insurance Company v. Connolly, Connolly & Huen LLP, et al., No. 17-1885, D. N.J., 2017 U.S. Dist. LEXIS 170325).



Judge Overrules Man's Objections To Testimony On Benefits Fraud Scheme
ANN ARBOR, Mich. - A federal judge in Michigan on Oct. 4 overruled a man's requests for acquittal and/or new trial, finding that testimony about his role in an unemployment benefits fraud scheme was not inflammatory and that sufficient evidence was presented by the government to support his conviction (United States of America v. Kenneth Dixon, No. 12-20668, E.D. Mich., 2017 U.S. Dist. LEXIS 164172).



Pediatric Firm Can Pursue Federal, State False Claims Act Allegations, Judge Says
NEWARK, N.J. - A firm of pediatric doctors can pursue allegations that a skilled nursing and rehabilitation facility violated the False Claims Act, the New Jersey False Claims Act (NJFCA) and the New York False Claims Act (NYFCA) for unlawfully billing Medicare and Medicaid as primary payers rather than a patient's private insurance company, a federal judge in New Jersey ruled Sept. 18, finding that the firm sufficiently stated claims under Federal Rule of Civil Procedure 12(b)(6) (United States of America v. Wanaque Convalescent Center, et al., No. 14-6651, D. N.J., 2017 U.S. Dist. LEXIS 150566).



Insurance Fraud Defendants' Emailed Defenses Were Improper, Judge Rules
TRENTON, N.J. - A federal judge in New Jersey on Sept. 19 struck defenses submitted via email by three defendants accused by Government Insurance Co., GEICO Indemnity Co., GEICO General Insurance Co. and GEICO Casualty Co. (collectively GEICO) of submitting approximately $3.3 million in false insurance claims, ruling that emails to counsel are not the proper procedure for responding to a lawsuit (Government Employees Insurance Company, et al. v. Hamilton Health Care Center, P.C., et al., No. 17-0674, D. N.J., 2017 U.S. Dist. LEXIS 151772).



Pharmacist Sentenced To 1 Year, 1 Day In Prison, Ordered To Pay $2.4M
GREENVILLE, N.C.- A North Carolina pharmacist was sentenced to one year and one day in prison by a federal judge on Oct. 10 and ordered to pay $2.4 million in restitution for submitting fraudulent bills to Medicare and the North Carolina Medicaid program (United States of America v. Justin Lawrence Daniel, No. 17cr148, E.D. N.C.).



Judge Upholds Convictions For Fraud Scheme Involving Urine Drug Screenings
FRANKFORT, Ky. - A federal judge in Kentucky on Sept. 29 affirmed a jury's decision to convict two physicians who owned addiction clinics, as well as the partial owners of a laboratory that conducted screenings for urine drug tests, of 17 counts of aiding and abetting one another to commit health care fraud, finding that the evidence was sufficient to support the verdict and that the jury's conclusion was not manifestly unjust (United States of America v. Robert L. Bertram, M.D., et al., No. 15-cr-14-GVFT-REW, E.D. Ky., 2017 U.S. Dist. LEXIS 160884).



Judge Adjourns Fraud Trial So Defendant Can Review Recorded Sales Calls
NASHVILLE, Tenn. - A federal judge in Tennessee on Sept. 19 granted a motion filed by a man accused of orchestrating a telemarketing scheme to sell insurance products that were not major medical health insurance, finding that he should be allowed to review recordings of approximately 100,000 sales calls to establish a good faith defense (United States of America v. Timothy Thomas, No. 14-182, M.D. Tenn., 2017 U.S. Dist. LEXIS 152336).



Ohio Couple Sentenced, Ordered To Turn Over Home For Insurance Fraud
COLUMBUS, Ohio - A federal judge in Ohio on Sept. 18 sentenced a couple who owned a home health care company for their roles in an insurance fraud scheme that involved submitting falsified training sheets for nurses and aides and required them to turn over the $1 million home they built with the proceeds of their activities (United States of America v. Riyad Altallaa, et al., No. 16cr128, S.D. Ohio).



Health Care Facilities CEO Sentenced To 41 Months For Stealing Medicaid Funds
ST. LOUIS - The former CEO of long-term health care facilities in Missouri, Kentucky and Texas was sentenced to 41 months in prison by a federal judge in Missouri on Oct. 6 and ordered to pay $667,201.85 in restitution after pleading guilty to two counts of health care fraud for stealing funds from Medicaid and using them to support his own lifestyle (United States of America v. John Mac Sells, No. 17cr178, E.D. Mo.).



Woman Sentenced To 1 Year In Prison For Health Care Fraud
NEW ORLEANS - A federal judge in Louisiana on Oct. 13 sentenced a woman to one year and one day in prison and ordered her to pay $536,724 in restitution after she pleaded guilty to one count of health care fraud for misappropriating Medicaid funds received by a pediatric clinic where she worked for her to pay off unauthorized charges on a business credit card (United States of America v. Monica Sylvest, No. 17cr24, E.D. La.).



Woman Convicted For Taking Kickbacks In Medicare Fraud Scheme
NEW ORLEANS - A woman was found guilty by a federal jury in Louisiana on Sept. 12 of paying and receiving kickbacks, identity theft and making false statements as part of a $2.1 million Medicare fraud scheme (United States of America v. Kim Ricard, et al., No. 15cr232, E.D. La.).



Podiatrist Convicted Of 4 Counts Of Health Care Fraud For Billing Scheme
NASHVILLE, Tenn. - A federal jury in Tennessee on Sept. 27 found a podiatrist guilty of four counts of health care fraud for submitting bills for surgeries he never performed and prescribing medically unnecessary ankle braces (United States of America v. John J. Cauthon, No. 15-cr-172, M.D. Tenn.).



5th Circuit Affirms Doctor's Convictions For Health Care Fraud, Kickbacks
NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Aug. 17 affirmed a jury's verdict convicting a man of committing health care fraud and paying and receiving kickbacks for approving patients for home health care when they did not need such treatment (United States v. Warren Dailey, No. 16-20517, 5th Cir., 2017 U.S. App. LEXIS 15595).



Insurer's Fraud Suit Against Mail Order Pharmacy Is Timely, Judge Rules
TRENTON, N.J. - An insurance company's lawsuit accusing a mail order pharmacy of submitting fraudulent claims is timely, a federal judge in New Jersey ruled Aug. 17, finding that the last claim submitted to the company was within the six-year statute of limitations (Horizon Blue Cross Blue Shield of New Jersey v. Focus Express Mail Pharmacy, Inc., et al., No. 17-571, D. N.J., 2017 U.S. Dist. LEXIS 131013).



Judge Adopts Recommendation To Deny Motion To Dismiss Fraud Indictment
MINNEAPOLIS - A federal judge in Minnesota on Aug. 31 adopted a magistrate judge's suggestion to deny a motion filed by three defendants to dismiss an indictment for counts of conspiracy to commit health care fraud and conspiracy to commit mail fraud, finding that the allegations in the indictment are sufficient (United States of America v. Huy Ngoc Nguyen, et al., No. 16-340, D. Minn., 2017 U.S. Dist. LEXIS 140789).



5th Circuit Finds Woman Was Deliberately Ignorant Of Medicare Fraud Scheme
NEW ORLEANS - A woman was properly convicted and sentenced to 140 months in prison for illegally billing Medicare more than $250,000 for medical equipment for beneficiaries that was not medically necessary, a Fifth Circuit U.S. Court of Appeals panel ruled Sept. 13, finding that she was deliberately ignorant of her scheme (United States of America v. Tracy Richardson Brown, No. 16-30933, 5th Cir.).



California Man Sentenced To 1 Year In Prison For Health Care Fraud Scheme
NEW ORLEANS - A federal judge in Louisiana on Sept. 7 sentenced a California man to one year in prison for his role in a $38 million health care fraud scheme that involved the sale and distribution of talking glucose meters that were not medically necessary (United States of America v. Geoffrey Ricketts, et al., No. 15cr153, E.D. La.).



6th Circuit: Allowing Agent's Testimony During Insurance Fraud Trial Was Proper
DETROIT - A federal judge in Michigan did not err when allowing a U.S. Drug Enforcement Agency agent to testify about wiretapped phone calls he reviewed as part of his investigation of an insurance fraud scheme, a Sixth Circuit U.S. Court of Appeals panel ruled Aug. 30, finding that the testimony was useful to the jury for explaining code words or framing parts of the investigation (United States of America v. Sanyani Edwards, No. 16-1168, 6th Cir., 2017 U.S. App. LEXIS 16828).



Judge: Dermatologist Convicted On Fraud Charges Does Not Deserve New Trial
CHICAGO - A federal judge in Illinois on Sept. 11 ruled that a dermatologist who was found guilty of eight counts of health care fraud and eight counts of making false statements related to health care matters is not entitled to a new trial, finding that the evidence presented by the government supported his conviction and that even if statements made by the prosecution during closing arguments were improper, they were not a reversible error (United States of America v. Omeed Memar, No. 15 CR 345, N.D. Ill., 2017 U.S. Dist. LEXIS 146306).



Maryland Appeals Court Finds Woman Waived Continuing Objection Over Fraud Evidence
ANAPOLIS, Md. - A Maryland appeals court panel on Sept. 11 ruled that a trial court did not err when admitting evidence related to a woman's fraudulent insurance claim for jewelry that was allegedly stolen, finding that she waived her right to appellate review because her attorney did not renew the objection after evidence outside of the claim was admitted (Phanta U. Daramy v. Maryland, No. 1373, September Term 2016, Md. Spec. App., 2017 Md. App. LEXIS 926).



Judge: Qui Tam Plaintiff's Insurance Fraud Claims Barred By Public Disclosure
SAVANNAH, Ga. - A federal judge in Georgia on Sept. 6 dismissed without prejudice a relator's claims under the qui tam provision of the False Claims Act (FCA) accusing two health care clinics and their providers of failing to submit reimbursements to Medicare, Medicaid and private insurers in 14 states for overpayments the clinics received, finding that the woman's claims are barred by public disclosure and that they did not meet the heightened pleading requirements of Federal Rules of Civil Procedure (8)(a) and 9(b) (United States of America, ex rel. Tracy Payton v. Pediatric Services of America, Inc., et al., No. 16-cv-102, S.D. Ga., 2017 U.S. Dist. LEXIS 144289).



Judge Dismisses 2 State Law Insurance Fraud Claims Against Woman
BEAUFORT, S.C. - Relators in a False Claims Act (FCA) lawsuit accusing a number of health care practices and their employees of submitting fraudulent bills for diagnostic services cannot pursue claims against a defendant company's employee under insurance fraud statutes in California and Illinois, a federal judge in South Carolina ruled Aug. 27, ruling that the relators did not present evidence showing that any claims were submitted to private insurers in those states (United States of America, ex rel. Scarlett Lutz, et al. v. Berkeley Heartlab, Inc., et al., No. 14-cv-00230, D. S.C., 2017 U.S. Dist. LEXIS 138722).



Judge Trims RICO Claims From Insurers' Fraud Suit, Finds No Enterprise
MINNEAPOLIS - A federal judge in Minnesota on Sept. 7 dismissed with prejudice claims asserted by four insurance companies that two chiropractors, their firms and individuals who allegedly recruited patients for the doctors violated the Racketeer Influenced and Corrupt Organizations Act, finding that the companies' allegations failed to show the existence of an enterprise (Illinois Farmers Insurance Company, et al. v. Timothy W. Guthman, et al., No. 17-270, D. Minn., 2017 U.S. Dist. LEXIS 144866).



Allstate Sufficiently States Claims For Fraudulent Billing Scheme, Judge Finds
DETROIT - A federal judge in Michigan on Aug. 23 ruled that Allstate Insurance Co. sufficiently alleged that a toxicology firm and its employees could be found liable for violating the Racketeer Influenced and Corrupt Organizations Act for submitting fraudulent claims for urine tests that were not medically necessary (Allstate Insurance Company v. Total Toxicology Labs LLC, et al., No. 16-12220, E.D. Mich., 2017 U.S. Dist. LEXIS 134517).



Woman Should Not Be Released Pending Appeal Of Fraud Conviction, Judge Says
SACRAMENTO, Calif. - A woman who was convicted on one count of making false statements to a grand jury as part of its investigation of a scheme involving fraudulent employment insurance benefits and disability claims should not be released on bail pending her appeal, a federal judge in California ruled Aug. 23, finding that the appeal does not raise substantial questions (United States of America v. Harjit Kaur Johal, No. 14-cr-00169-GEB, E.D. Calif., 2017 U.S. Dist. LEXIS 135345).



Appeals Court: Insurance Fraud Defendant Should Be Allowed To Represent Herself
VENTURA, Calif. - A woman facing four counts of insurance fraud should be allowed to represent herself for her upcoming trial, a California appeals panel ruled Aug. 23, finding that her request was timely and that she acknowledged that she knows her case "inside and out" (People v. Linda Michelle Boggess, No. B277790, Calif. App., 2nd Dist., 6th Div., 2017 Calif. App. Unpub. LEXIS 5795).