- Volume 25, Issue #1
- Divided 6th Circuit Reverses Dismissal Of Suit Over Senior Center's Billing
CINCINNATI - A woman's False Claims Act (FCA) lawsuit accusing a senior living center of failing to submit to Medicare certifications supporting the need for medical services for patients was reinstated June 11 by a 2-1 Sixth Circuit U.S. Court of Appeals panel, after it found that the woman's allegations satisfied the act's requirements for materiality and scienter (United States, ex rel. Marjorie Prather v. Brookdale Senior Living Communities Inc., et al., No. 17-5826, 6th Cir., 2018 U.S. App. LEXIS 15617).
- 2nd Circuit Upholds Sentence For 'Brazen' Employment Insurance Fraud Scheme
NEW YORK - A Second Circuit U.S. Court of Appeals panel on May 21 upheld a federal judge in New York's decision to sentence a man who pleaded guilty to fraudulently procuring $13,961 in unemployment insurance benefits from the New York Department of Labor while working as a correctional officer to six months in prison, holding that the judge sufficiently explained that the sentence was based on the brazen nature of the offense (United States v. Andrew Kessler, No. 17-2317-cr, 2nd Cir., 2018 U.S. App. LEXIS 13088).
- Judge Denies General Practitioner's Motion To Vacate Fraud Conviction
SAN JOSE, Calif. - A federal judge in California on June 8 denied a general practitioner's motion for acquittal on charges of health care fraud, finding that the spreadsheets and explanation of benefit (EOB) documents presented by the government constituted sufficient evidence showing that the doctor submitted fraudulent claims to insurance companies (United States v. Vilasini Ganesh, et al., No. 16cr00211, N.D. Calif., 2018 U.S. Dist. LEXIS 97028).
- Surgery Center's Consumer Fraud Counterclaim Against Insurers Dismissed By Judge
CHICAGO - A surgery center failed to sufficiently state a claim against two insurance companies for violating the Illinois Consumer Fraud Act (ICFA), a federal judge in Illinois ruled May 24, holding that the insurers' alleged misrepresentations to the center about whether its procedures were covered did not harm the patient population (Connecticut General Life Insurance Co., et al. v. Southwest Surgery Center LLC, No. 14-cv-8777, N.D. Ill., 2018 U.S. Dist. LEXIS 87551).
- Insurers Sufficiently Pleaded Fraud, RICO Claims Stemming From Scheme, Judge Rules
MINNEAPOLIS - A federal judge in Minnesota on May 25 refused to dismiss a lawsuit brought by seven insurance companies accusing the owners of a number of chiropractic clinics of scheming to submit more than $1.8 million in fraudulent bills, finding that the companies' fraud allegations satisfied the requirements of Federal Rule of Civil Procedure 9(b) and that the plaintiffs sufficiently stated claims under the Racketeer Influenced and Corrupt Organizations Act (Illinois Farmers Insurance Co., et al. v. Lake Street Chiropractic Clinic P.A., et al., No. 17-5090, D. Minn., 2018 U.S. Dist. LEXIS 87767).
- Opioid Addiction Treatment Center Owner Indicted For Insurance Fraud
PITTSBURGH - The owner of an opioid addiction treatment center was indicted in Pennsylvania federal court June 5 on charges of health care fraud, conspiracy to unlawfully distribute a controlled substance, and aiding and abetting the unlawful distribution of a controlled substance for allegedly dispensing buprenorphine, a drug used to treat addiction, and submitting fraudulent claims to Medicare and Medicaid for the drug (United States v. Jennifer Hess, No. 18cr142, W.D. Pa.).
- Panel: Trial Court Must Recalculate Restitution For Insurer's Investigation
RIVERSIDE, Calif. - An appeals court panel in California on May 31 vacated a trial court judge's ruling ordering a woman who pleaded guilty to one count of making a false statement in support of an insurance claim to pay $1,042.17 in restitution to an insurance company, finding that the company did not take into account the costs it incurred as a result of its investigation of the defendant's claim (People of California v. Alyce J. Williams, No. D072783, Calif. App., 4th Dist., 1st Div., 2018 Cal. App. Unpub. LEXIS 3728).
- Pennsylvania Appeals Panel Affirms Woman's Conviction For Arson, Insurance Fraud
PITTSBURGH - A Pennsylvania appeals court panel on May 31 affirmed a woman's conviction and 20- to 40-month sentence for insurance fraud and arson, finding that she received effective assistance of counsel (Pennsylvania v. Julia Ann Calipo, No. 1929 WDA 2016, Pa. Super., 2018 Pa. Super. Unpub. LEXIS 1861).
- Panel Affirms Finding That Insurance Fraud Defendant's Counsel Was Effective
PHILADELPHIA - A Pennsylvania appeals panel on May 28 affirmed a trial court's ruling denying a man's request for relief under the Post Conviction Relief Act (PCRA) following his convictions for insurance fraud, corrupt organizations and identity theft, holding that the lower court judge did not err when finding that the man received effective assistance of counsel (Pennsylvania v. Michael David Ruth, No. 411 EDA 2017, Pa. Super., 2018 Pa. Super. LEXIS 1737).
- Judge Stays Coverage Suit Pending Insurer's Liquidation Proceedings
CHICAGO - An Illinois federal judge on June 1 stayed a coverage dispute between an insolvent Missouri insurer and an insured doctor regarding coverage provided under a professional liability insurance policy pending the duration of the liquidation proceedings (Galen Insurance Co. v. Vittorio Guerriero, M.D., et al., No. 15-06993, N.D. Ill., 2018 U.S. Dist. LEXIS 91393).
- Judge Quashes Subpoenas Seeking Records Of All Of Doctor's Toenail Avulsions
NASHVILLE, Tenn. - A federal judge in Tennessee on May 18 quashed two subpoenas served on rehabilitation centers where a doctor who was found guilty of four counts of health care fraud performed toenail avulsions, finding that the requests were unduly burdensome and that they were not necessarily relevant for the calculation of the amount of loss incurred by Medicare and other insurers (United States v. John J. Cauthon, No. 15-cr-00172, M.D. Tenn., 2018 U.S. Dist. LEXIS 84104).
- Panel: Judge Erred When Modifying Plea Agreement For Lawyer Accused Of Fraud
TRENTON, N.J. - A New Jersey appeals court panel on June 5 reversed a judge's decision to grant a request for pretrial intervention (PTI) from an attorney accused of insurance fraud, finding that the judge erred when vacating a different judge's previous ruling denying the request (New Jersey v. Neal Pomper, No. A-3969-16T1, N.J. Super., App. Div., 2018 N.J. Super. Unpub. 1305).
- Farmers Indicted On False Claims For Reinsured Crop Insurance Program
LEXINGTON, Ky. - Farmers defrauded the United States through the filing of false insurance claims reimbursed by the U.S. Department of Agriculture (USDA) and by making false statements and reports in connection with the federally reinsured crop insurance program, the government alleges in a June 6 indictment filed in a Kentucky federal court (United States v. Bradley Price, et al., No. 18-cr-60, E.D. Ky.).