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Mealey's Insurance Fraud

  • 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

    New York 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.

  • June 18, 2025

    Lower Court Properly Found Auto Insurer Acted Reasonably In Handling Claim

    SEATTLE — A district court did not err in finding that an auto insurer acted reasonably in handling an insured’s claim for lost wages and damages following the insured’s involvement in an auto accident and also did not err in finding that the insurer’s filing of a counterclaim for fraud was not an act of insurance bad faith, the Ninth Circuit U.S. Court of Appeals said in affirming the district court’s ruling.

  • June 17, 2025

    Split West Virginia Court Reverses Ruling On Insurer’s Setoff In Fire Coverage Row

    CHARLESTON, W. Va. — In a dispute over fire damage coverage regarding alleged arson and fraud, a split West Virginia appellate court reversed and remanded a lower court’s ruling that denied the homeowners insurer with a setoff for contractual damages by the amount paid by the insurer to satisfy the homeowners’ mortgage, finding that the insurer preserved its right for a setoff.

  • June 16, 2025

    Florida Panel Reverses Judgment For Homeowner In Row Over Fire Damage Coverage

    DAYTONA BEACH, Fla. — A Florida appellate court on June 13 reversed and remanded a lower court’s ruling granting summary judgment to a homeowner in her dispute with the Florida Insurance Guaranty Association (FIGA) over coverage for fire damage, finding that material issues of fact remain regarding whether the homeowner’s husband, another insured under the policy, violated a policy provision regarding fraud.

  • June 13, 2025

    Calif. Panel Affirms $200K Judgment Against Life Policy Beneficiary In Fraud Row

    LOS ANGELES — A California appellate court on June 12 affirmed a lower court judgment awarding a decedent’s son $35,000 for elder abuse and the decedent’s estate $165,000 for unjust enrichment against the woman the son sued alleging fraud in her making herself a beneficiary under the decedent’s $200,000 life insurance policy, finding no need for the jury to consider whether the beneficiary change was related to fraud because the damages finding in a jury question addressed the fraud presumption.

  • June 12, 2025

    Judge Adopts Recommendation To Award GEICO Attorney Fees In No-Fault Fraud Dispute

    TAMPA, Fla. — A Florida federal judge adopted in full a magistrate judge’s report and recommendation advising that the court grant GEICO’s motion for attorney fees in a case where the court previously entered a $690,251.44 judgment for the insurer in its suit against a health care clinic and related parties for allegedly submitting fraudulent no-fault insurance charges.

  • June 11, 2025

    Neb. Panel Reverses Judgment For Insurer In $75K Life Policy Misrepresentation Row

    LINCOLN, Neb. — The Nebraska Court of Appeals on June 10 reversed and remanded a lower court order granting summary judgment to a life insurer in a dispute with the beneficiary of a $75,000 life insurance policy regarding alleged material misrepresentations in the policy application, finding that there is a fact dispute about an insurance agent’s knowledge of the insured’s back surgery that could be imputed to the insurer.

  • June 10, 2025

    Judge Denies CVS’s Directed Verdict Motion In FCA Dispute With Government

    NEW YORK — After a jury delivered a verdict against CVS Health Corp. (CVSHC) but said CVSHC’s conduct did not result in damages to the government in a federal False Claims Act (FCA) suit alleging submission of fraudulent claims for payment to the government, a New York federal judge denied CVSHC’s motion for a directed verdict, finding that the government’s “evidence demonstrates more than the type of conduct or lack of conduct that has been held insufficient in other False Claims Act cases.”

  • June 09, 2025

    Insurer’s Motion To Compel Granted In Row Over Coverage For Underlying FCA Suit

    BUFFALO, N.Y. —  A New York federal magistrate judge granted an insurer’s motion to compel discovery in a dispute over whether its insureds are entitled to coverage in an underlying qui tam suit alleging violations of the federal False Claims Act (FCA) regarding Medicare fraud, finding in part that the policyholders’ argument that the motion is barred by delay lacks “merit.”

  • June 06, 2025

    Motion To Compel Partially Granted In Coverage Dispute With Debris Removal Company

    NEW YORK  — Agreeing with an insured debris removal company and its principal that an insurer’s discovery request covering a 10-year period is “overly broad,” a New York federal judge partially granted the motion to compel discovery in an insurer’s suit seeking to rescind two insurance policies for purported fraudulent misrepresentations in insurance applications, granting discovery limited to one year before the initial policy application and until the end of the last policy renewal period.

  • June 04, 2025

    Judge Denies CEO Dismissal Bid In FCA Suit Against Lab Alleging Illegal Kickbacks

    SHERMAN, Texas — A Texas federal judge denied a dismissal motion filed by the CEO of a former laboratory accused, along with other individuals and entities, of violating the federal False Claims Act (FCA) and Anti-Kickback Statute (AKS) through payment of illegal kickbacks to doctors and medical practices and fraud against government insurers by billing them for medically unnecessary tests, finding that “dismissal is not warranted.”

  • June 02, 2025

    Panel Affirms Ruling Granting Summary Disposition For Insurer In PIP Dispute

    DETROIT — A Michigan appellate court affirmed a lower court ruling granting summary disposition in favor of an insurer in a personal injury protection (PIP) dispute between an insurer and a man injured in an auto accident seeking no-fault coverage, finding “no genuine issue of material fact that plaintiff committed a fraudulent insurance act.”

  • May 30, 2025

    Insurance Magnate Files Objections To Presentence Report In Money Laundering Case

    CHARLOTTE, N.C. — Insurance magnate Greg Lindberg filed under seal objections to a presentence investigation report after he 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.

  • May 29, 2025

    Magistrate Recommends Granting Judgment To Life Insurer In Row Over $400K Policy

    FORT MYERS, Fla. — A Florida federal magistrate judge on May 28 issued a report and recommendation advising granting default judgment to an insurer in its suit seeking to rescind a $400,000 life insurance policy for alleged policy application material misrepresentations regarding health status, finding that because the allegations in the complaint are deemed admitted by the insured’s default, the insurer is permitted to rescind the policy.

  • May 28, 2025

    Majority Reverses Punitive Damages Ruling In Suit Arising From Hurricane Florence

    RALEIGH, N.C. — A majority of the North Carolina Supreme Court affirmed an appeals court majority’s holding that an insured’s allegations are sufficient to state a claim for negligence against an insurance agent in a lawsuit arising from Hurricane Florence property damage but  reversed its ruling as to the punitive damages claim.

  • May 28, 2025

    Motion To Set Aside Default Granted For ‘Good Cause’ In FCA Retaliation Suit

    RALEIGH, N.C. — A North Carolina federal judge on May 27 granted a dermatology practice’s motion to set aside the court clerk’s entry of default in a former employee’s suit accusing the practice of violating the federal False Claims Act (FCA) by terminating his employment in retaliation for complaints about purported fraudulent billing to Medicare, finding “good cause” to set aside the entry of default for delays that seem to be the fault of the practice’s prior attorney.

  • May 28, 2025

    After Reversal, Judge Orders Reopening Of FCA Suit Over CPAP Billing To Tricare

    ATLANTA —  On remand from the 11th Circuit U.S. Court of Appeals’ partial reversal of a district court’s order dismissing a qui tam complaint against a company and its subsidiary supplier of continuous positive air pressure (CPAP) sleep apnea devices, a Florida federal judge ordered reopening of the suit alleging violations of the federal False Claims Act (FCA) for purported fraudulent billing to government health insurers, including Tricare

  • May 27, 2025

    Connecticut Judge Grants Strike Motion In Father And Son Life Insurance Dispute

    DANBURY, Conn. — A Connecticut state court judge granted a motion to strike a complaint’s single claim of intentional misrepresentation in a dispute between a father and son over the son’s alleged fraud in forging his father’s signature on a life insurance application, finding that the father failed to plead the required elements for an intentional misrepresentation claim.

  • May 23, 2025

    Protective Order Motion Denied In Insurance Coverage Dispute Over Maserati Loss

    INDIANAPOLIS — Denying a motion for a protective order on May 22, an Indiana federal magistrate judge said an insured suing State Farm over its alleged bad faith failure to compensate him for the loss of his Maserati must respond to State Farm’s discovery requests because the insured failed “to show the good cause required to obtain the requested protective order.”

  • May 23, 2025

    Motion To Amend Granted In Insurance Coverage Dispute Over Misrepresentations

    SALT LAKE CITY — A Utah federal magistrate judge granted insureds’ motion to amend in a commercial general liability insurer’s suit seeking a declaration that it owes no duty to defend the insureds in underlying litigation based upon alleged misrepresentations in the insurance application, finding that the insureds have shown good cause to file an amended answer due to the insurer purportedly not timely notifying them of its intention to seek rescission.

  • May 20, 2025

    Judge Grants GEICO’s Motion To Stay Other Suits In RICO Case Against Providers

    BROOKLYN, N.Y. — In a suit alleging Racketeer Influenced and Corrupt Organizations Act (RICO) violations against multiple diagnostic imaging providers and related parties, a New York federal judge on May 19 granted GEICO’s motion for a preliminary injunction to stay pending no-fault collection arbitration and state court suits and enjoin the filing of similar actions against GEICO by those providers, finding that pursuant to a recent ruling by the Second Circuit U.S. Court of Appeals, district courts can enjoin state court proceedings.