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April 25, 2025
MOBILE, Ala. — An Alabama federal judge entered default judgment against an insured’s caregiver, who allegedly defrauded long-term care (LTC) insurer John Hancock Life Insurance Co., for failing to provide the more than $167,000 in services for which the caregiver received reimbursement, finding that because the caregiver failed to respond to the complaint or attend a court-ordered hearing, the complaint’s allegations, including that the caregiver was under investigation for elder abuse of the insured, are considered admitted.
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April 24, 2025
CINCINNATI — The Sixth Circuit U.S. Court of Appeals affirmed a lower court’s dismissal of a suit filed by relator physicians against a hospital and its parent company alleging violations of the False Claims Act (FCA) and related Michigan law for purported fraud in submitting claims for payment to government insurers for emergency room patients who were boarded as inpatient patients but received allegedly deficient care in the ER before a bed was available for them, finding that the allegations fail to satisfy the particularity required for fraud pursuant to the Federal Rules of Civil Procedure.
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April 22, 2025
BROOKLYN, N.Y. — A New York federal magistrate judge on April 21 granted a pharmaceutical company’s motion to compel in a Lanham Act trademark infringement case, seeking documents related to fee arrangement between defense counsel and his client, who pleaded guilty to conspiracy to commit health care fraud in a related case, finding in part that “the requested information is relevant” because plaintiffs in Lanham Act suits may recover a defendant’s profits.
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April 22, 2025
ATLANTA — The 11th Circuit U.S. Court of Appeals reversed in part and remanded a ruling by a lower court dismissing a qui tam complaint against a company and its subsidiary supplier of continuous positive air pressure (CPAP) sleep apnea devices, alleging violations of the federal False Claims Act (FCA) for purported fraudulent billing to government health insurers, including Tricare, finding that while the relator pleaded with specificity a claim for alleged fraud for upcoding, the “remaining claims fall well short of the mark.”
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April 21, 2025
DES MOINES, Iowa — An Iowa appeals court panel held that a landscaping company’s insurance coverage for damage caused by an August 2020 derecho was voided by the insured’s material misrepresentations, affirming a lower court.
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April 17, 2025
SAN JOSE, Calif. — In a one-page order without providing explanation, the Ninth Circuit U.S. Court of Appeals denied a petition for panel rehearing of its ruling affirming a lower court’s dismissal of a qui tam relator’s suit accusing pharmaceutical companies of violating the False Claims Act (FCA) by overcharging the federal government and states under Medicare and Medicaid.
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April 16, 2025
NEW ORLEANS — A Louisiana federal magistrate judge on April 15 granted an insurer’s motion to disqualify the insured’s counsel in a dispute over insurance coverage for hurricane damage and purported fraud over the estimates submitted to the insurer, finding in part that a conflict of interest exists due to the close business relationship between one of the insured’s attorneys and a restoration service used by the insured.
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April 16, 2025
DETROIT — A Michigan appellate court affirmed a lower court order denying summary disposition to an auto insurer in a personal injury protection (PIP) auto accident dispute but reversed the lower court’s ruling dismissing the PIP-assigned insurer, finding that disputes remain regarding an alleged material misrepresentation in the policy application and whether the son of the insured, who was injured in the accident, is an innocent third party.
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April 15, 2025
NEW YORK — The Second Circuit U.S. Court of Appeals on April 14 affirmed a lower court ruling dismissing a qui tam suit alleging violations of the False Claims Act (FCA) against Zocdoc Inc., an internet-based company that enables individuals to search for medical providers, finding that the lower court correctly dismissed the suit and that the complaint failed to allege that Zocdoc acted with the scienter required under the FCA and the Anti-Kickback Statute (AKS) in assessing a booking fee for medical providers.
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April 14, 2025
COLUMBUS, Ohio — An Ohio federal judge on April 11 denied an insurer’s motion for default judgment against its insured in a declaratory judgment suit seeking to rescind two $500,000 life insurance policies for the insured’s purported misrepresentations regarding his health history, finding that the insurer failed to address why the insured was appropriately served in the motion for default judgment.
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April 11, 2025
PHILADELPHIA — The Third Circuit U.S. Court of Appeals on April 10 affirmed a lower court’s dismissal of a qui tam relator’s suit against Bayer Corp., Johnson & Johnson, Merck & Co. and other pharmaceutical companies, alleging that “hiding” side effects of their antibiotics from the U.S. Food and Drug Administration “caused fraudulent claims to be submitted to Medicaid and Medicare,” finding that the relator failed to satisfy the essential elements of a False Claims Act (FCA) violation.
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April 10, 2025
NEW HAVEN, Conn. — A Connecticut federal magistrate judge denied a motion to quash and for a protective order filed by a dental practice and related parties seeking to stop the enforcement of a dental licensing statute prohibiting dental assistants from using radiology services without required training, finding that the motion to quash a subpoena for documents related to the Connecticut attorney general’s investigation into the practice’s alleged Connecticut False Claims Act violations for claims made to Medicaid “is premature.”
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April 10, 2025
WILMINGTON, Del. — Three days after an insured and one of its insurers filed a stipulation asking a Delaware court to dismiss with prejudice all claims against the insurer in a professional liability coverage dispute arising from a Medicaid fraud investigation, the judge ordered the case against the insurer dismissed.
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April 09, 2025
DETROIT — In a case on remand from the Michigan Supreme Court, a Michigan appellate court reversed a lower court’s ruling granting summary disposition to an insurer in a personal injury protection (PIP) dispute over whether alleged fraudulent answers to an interrogatory by an estate’s representative constituted material misrepresentations pursuant to Michigan law, finding that issues of fact remain regarding whether the representative knew the answers constituted false information.
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April 09, 2025
MIAMI — A Florida federal magistrate judge granted in part Wells Fargo’s motion to withhold discovery in a putative class action alleging that Wells Fargo aided and abetted fraud in a “massive” Ponzi scheme purportedly orchestrated by owners of insurers, some of which are now in receivership, resulting in elderly investor victims losing more than $300 million after scheme operators sold them promissory notes secured by collateral in stranger-oriented life insurance policies (STOLIs).
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April 08, 2025
CINCINNATI — The Sixth Circuit U.S. Court of Appeals on April 7 affirmed a lower court’s ruling dismissing a suit filed by a framing subcontractor against a general contractor alleging that the general contractor committed insurance fraud in submitting claims to an insurer based on the subcontractor’s purported breach of contract, finding that the subcontractor failed to allege any injury caused by the purported insurance fraud.
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April 08, 2025
LEXINGTON, Ky. — A Kentucky federal judge adopted a magistrate judge’s report and recommendation to grant partial judgment on the pleadings to a homeowners insurer in its breach of contract suit against its insured seeking a return of a $100,000 insurance settlement issued to the insured prior to his insurance fraud conviction, finding that because the parties filed no objections, the court grant will grant the motion and hold that the insured breached the policy.
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April 07, 2025
ALBANY, Ga. — A Georgia federal judge granted in part and denied in part a motion for summary judgment filed by a life insurer in a breach of contract and bad faith suit against it by the beneficiary of a $70,000 life insurance policy, finding in part that a dispute of facts remains as to whether the decedent made misrepresentations in the policy application.
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April 04, 2025
KANSAS CITY, Mo. — A Missouri federal judge granted a life insurer’s motion for default judgment after the insured failed to defend or plead in the insurer’s declaratory judgment suit seeking to rescind and void a $212,000 life insurance policy due to the insured’s alleged fraud regarding his misrepresentation in the policy application about not using marijuana in the last 24 months, which purportedly contradicts his medical records indicating a diagnosis of cannabis dependence.
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April 04, 2025
BOISE, Idaho — An Idaho federal judge granted in part and denied in part USAA’s motion to dismiss in a life insurance beneficiary’s suit against it over USAA’s alleged refusal to pay benefits pursuant to a $750,000 life insurance policy due to purported misrepresentations in the policy application, denying dismissal as to the breach of contract claim because the operative complaint fails to show the misrepresentations were material.
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April 03, 2025
ORLANDO, Fla. — After a nine-day jury trial in which a jury issued an award of over $1.9 million to Prudential Insurance in its suit alleging that a Florida couple fraudulently received benefits under their long-term care (LTC) insurance policies, a Florida federal judge issued an order entering judgment in Prudential’s favor, stating that Prudential will recover more than $1.9 million in damages from the couple.
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April 02, 2025
PHILADELPHIA — The Third Circuit U.S. Court of Appeals on April 1 affirmed a lower court ruling dismissing a qui tam suit filed by a relator on behalf of the U.S. government and multiple states alleging that owners and operators of more than 200 nursing homes operating across the U.S. violated the federal False Claims Act (FCA) by overbilling Medicare and Medicaid, finding that the lower court correctly determined that the relator failed to plead fraud with the specificity required under the Federal Rules of Civil Procedure.
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April 02, 2025
WILMINGTON, Del. — An insured and one of its insurers filed a stipulation asking a Delaware court to dismiss with prejudice all claims against the insurer in a professional liability coverage dispute arising from a Medicaid fraud investigation.
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April 01, 2025
JACKSON, Miss. — A Mississippi federal judge on March 31 granted in part and denied in part a life insurer’s motion for summary judgment in a suit filed by the insured’s family against the life insurer for its refusal to pay the $500,000 death benefit under the policy, finding that the bad faith and punitive damages claims are dismissed absent remaining issues of material fact on those claims.
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April 01, 2025
TAMPA, Fla. — A Florida federal judge denied GEICO’s dismissal motion in a defamation and tortious interference suit filed against it by a company assisting hospitals with recovery for third-party liability claims under Florida personal injury protection (PIP) law and the company’s owner, finding that dismissal is denied as to the defamation claim because GEICO failed to raise new arguments in earlier dismissal motions and that GEICO failed to “provide a basis” to dismiss the claim for tortious interference.