LexisNexis® Mealey's™ Insurance Fraud Legal News http://www.lexisnexis.com/mealeys/news.aspx Headline Insurance Fraud Legal News from LexisNexis® en-us LexisNexis® Headline Insurance Fraud Legal News http://www.lexisnexis.com/mealeys/images/lexismealeyslogo.gif 130 29 http://www.lexisnexis.com/mealeys/news.aspx Copyright 2013 http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Hospital Owner, Executives Arrested For Medicare Scheme CHICAGO - The owner, executive officers and four doctors associated with an Illinois acute care hospital were charged in a criminal complaint filed April 16 in Illinois federal court with participating in a Medicare referral kickback conspiracy (United States of America v. Edward J. Novak, et al., No. 1:13-cr-00312, N.D. Ill.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Patient Recruiter In Florida Sentenced For Part In Fraud Scheme MIAMI - A patient recruiter who pleaded guilty to conspiracy to defraud was sentenced in a Florida federal court on April 2 to 36 months in prison (United States of America v. Vladimir Jimenez, No. 1:12-20700, S.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge Denies Motion To Arbitrate No-Fault Claims BROOKLYN, N.Y. - A New York federal judge on April 8 denied medical provider defendants' motion to compel arbitration of already-paid no-fault claims (Allstate Insurance Co. v. David Mun, M.D., et al., No. 12-cv-3791, E.D. N.Y.; 2013 U.S. Dist. LEXIS 50421). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Default Judgment Is Proper Sanction, Judge Holds DETROIT - A default judgment against health care defendants who refused to comply with repeated discovery requests in an insurer's fraud action is a proper sanction, a Michigan federal judge ruled April 3 (Allstate Insurance Co., et al. v. Awan & Associates, P.C., et al., No. 1111988, E.D. Mich.; 2013 U.S. Dist. LEXIS 48100). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Arguments Raised 1st Time On Appeal Are Waived, Court Rules DETROIT - The Sixth Circuit U.S. Court of Appeals on April 8 upheld dismissal of an insurer's claims for conspiracy and Racketeer Influenced and Corrupt Organizations Act violations against several medical providers and rehabilitation centers, finding that the insurer's claim raised for the first time on appeal is waived (Allstate Insurance Co. v. Global Medical Billing Inc., et al., No. 12-1263, 6th Cir.; 2013 U.S. App. LEXIS 7277). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge: Insurer's Denial In Arson Case Reasonable ATLANTA - A liability insurer that denied a fire loss claim arising from arson was reasonable, a Georgia federal judge ruled April 3 (JC&C Inc. v. Peerless Indemnity Insurance Co., No. 1:11-CV-3591, N.D. Ga.; 2013 U.S. Dist. LEXIS 48069). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Insured Had No Insurable Interest In Property, Judge Holds BIRMINGHAM, Ala. - An Alabama federal judge on March 28 granted a commercial and general property insurer summary judgment in a declaratory judgment action arising from a fire loss claim, finding that the insured did not have an insurable interest in the property (Nationwide Mutual Fire Insurance Co. v. Guster Law Firm, LLC, et al., No. 2:11-cv-1183-AKK, N.D. Ala.; 2013 U.S. Dist. LEXIS 45767). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge: Issues Of Fact Preclude Summary Judgment On Rescission SAN FRANCISCO - Issues of fact as to what an insurer knew and whether its decision to try to rescind a policy was timely preclude summary judgment, a California federal court ruled April 9 in a declaratory judgment action (Probuilders Specialty Insurance Co., RRG v. Valley Corp., et al., No. 5:10-CV-05533, N.D. Calif.; 2013 U.S. Dist. LEXIS 51159). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Insurer Is Entitled To Rescind Policy, Judge Rules BIRMINGHAM, Ala. - A professional liability insurer is entitled to rescind a policy based on an insured's material misrepresentations on the policy application, an Alabama federal judge ruled April 10 (Carolina Casualty Insurance Co. v. Law Offices of Robert M. Pears, P.C., et al., No. 2:12-CV-01828, N.D. Ala.; 2013 U.S. Dist. LEXIS 51526). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-11%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Bankruptcy Judge: Insurer's $378M Fraud Case Against JPMorgan Stayed BIRMINGHAM, Ala. - The federal bankruptcy judge presiding over the Chapter 9 proceeding of Jefferson County, Ala., on April 15 ruled that an insurer who alleges that it was fraudulently induced to provide $378 million in insurance coverage could not pursue its lawsuit because of the automatic stay (In Re: Jefferson County, Ala., No. 11-05736, Chapter 9, N.D. Ala. Bkcy.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge Issues Stay Of Pending Arbitrations, Enjoins Future Filings BROOKLYN, N.Y. - A New York federal judge on March 11 issued a temporary stay of pending arbitration actions and enjoined any future filings during the pendency of a fraud action in a dispute over benefits under the state's no-fault law (Allstate Insurance Co., et al. v. Hisham Elzanaty, et al., No. 11-3862, E.D. N.Y.; 2013 U.S. Dist. LEXIS 33309). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Florida Judge Sentences Home Health Care Operators For Fraud MIAMI - The owner and manager of a home health care center were sentenced to time in prison and ordered to pay restitution for conspiracy to commit health care fraud in Florida on Feb. 28 (United States of America v. Rogelio Rodriguez, et al., No. 12-20750, S.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Former Florida Doctor Sentenced To Prison For His Role In Fraud MIAMI - A Florida federal judge on March 15 sentenced a former medical doctor to 144 months in prison for conspiracy to commit health care fraud and health care fraud for his participation in a scheme to defraud Medicare (United States of America v. Gary Kushner, No. 1:11-20587, S.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DME Wholesale Providers Plead Guilty To Fraud LOS ANGELES - Two former owners of a durable medical equipment (DME) supplier pleaded guilty Feb. 25 to conspiracy to commit health care fraud in a California federal court (United States of America v. Rajinder Singh Paul, et al., No. 12-921, C.D. Calif.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Indiana Federal Judge Denies Dismissal Of False Claims Qui Tam Suit INDIANAPOLIS - A federal judge in Indiana on Feb. 21 mostly denied three motions to dismiss a qui tam action filed under the federal False Claims Act (FCA) and the Indiana False Claims Act (IFCA) against a neurosurgical practice and several of its current and former physicians. The judge concluded that the relators' second amended complaint was sufficiently pleaded to survive a motion to dismiss (United States of America, et al., ex rel. Tom Herron, et al. v. Indianapolis Neurosurgical Group Inc., et al., No. 1:06cv1778, S.D. Ind., Indianapolis Div.; 2013 U.S. Dist. LEXIS 23610). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Material Misrepresentation Voids Policy, Illinois Federal Judge Rules CHICAGO - An applicant who failed to disclose a change in his medical condition prior to finalizing the issuance of a life insurance policy committed a material misrepresentation, an Illinois federal court ruled March 15 (Riversource Life Insurance Co. v. Amy Plumbing, Heating & Cooling Inc., No. 12-C-1388, N.D. Ill.; 2013 U.S. Dist. LEXIS 36541). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Insured's Material Misrepresentation Voids Coverage, Judge Holds SOUTH BEND, Ind. - An Indiana federal judge on March 12 ruled that a homeowner's insurer is entitled to rescind its policy based on an insured's material misrepresentation on the application (Dorothy Doaks v. Safeco Insurance Company of America, No. 3:09-CV-367, N.D. Ind.; 2013 U.S. Dist. LEXIS 33573). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Evidence Supports Claim Denial Due To Misrepresentation LOS ANGELES - The Second District California Court of Appeal on March 14 upheld a jury's verdict finding that an insurer's benefit denial for a fire loss was reasonable based on a claimant's misrepresentations on her policy application (Kerri Roepel, et al. v. Pacific Specialty Insurance Co., No. B230306, Calif. App., 2nd Dist.; 2013 Cal. App. Unpub. LEXIS 1883). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Failure To Disclose Financial Records Voids Policy, Judge Holds CINCINNATI - A claimant's failure to disclose financial documents in light of an arson defense and a large tax liability voids coverage under a homeowners policy, an Ohio federal judge ruled Feb. 22 (Namon Joseph v. State Farm Fire and Casualty Co., No. 2:11-cv-794, S.D. Ohio; 2013 U.S. Dist. LEXIS 24511). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Policy Cancellation For Misrepresentations Affirmed By Indiana Supreme Court INDIANAPOLIS - The Indiana Supreme Court on March 5 affirmed a trial court's summary judgment ruling, holding that an insurer was entitled to deny a claim and cancel a policy based on the insureds' misrepresentations in their insurance application (Michael Dodd, et al. v. American Family Mutual Insurance Co., No. 12S02-1203-CT-170, Ind. Sup.; 2013 Ind. LEXIS 167). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-10%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Court: Issues Of Fact Over Representations Preclude Judgment LITTLE ROCK, Ark. - Disputed issues of fact over an insured's representations regarding coverage preclude summary judgment, an Arkansas appeals court ruled March 13 (Nationwide Mutual Insurance Co. v. John Matthews, et al., No. CA12-613, Ark. App.; 2013 Ark. App. LEXIS 202). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Auto Insurer's RICO, Fraud Claims To Proceed, Judge Holds DETRIOT - An automobile insurer can proceed with its fraud and racketeering claims against two physical therapy clinics, their officers and physicians, a Michigan federal judge ruled Feb. 12, denying the defendants' motion to dismiss (State Farm Mutual Automobile Insurance Co. v. Physiomatrix Inc., et al., No. 12-11500, E.D. Mich.; 2013 U.S. Dist. LEXIS 18501). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Florida Doctor To Pay $26.1M To Settle False Claims Dispute TAMPA, Fla. - A Florida physician reached a settlement Feb. 11 with the United States to pay $26.1 million to resolve claims that he violated the False Claims Act. The government alleged that the physician performed medically unnecessary procedures and received kickbacks from a pathology lab for sending business its way (United States of America, ex rel. Alan M. Freedman, M.D. v. Jose SuarezHoyos, M.D., et al., No. 8:04-cv-933-T-24EAJ, M.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Florida Nurse Sentenced To Prison For His Part In Fraud MIAMI - A Florida federal judge on Feb. 12 sentenced a former registered nurse to 111 months in prison for his role in a Medicare fraud scheme (United States of America v. John Thoen, No. 1:12-20291, S.D. Fla.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge: Insured Who Concealed His Existence Is Liable For Fraud PHOENIX - An insured under a $800,000 life insurance policy who disappeared and concealed his existence while beneficiaries to the policies received death benefits is liable for fraud, an Arizona federal judge ruled Feb. 12, granting the life insurer summary judgment (Liberty Life Insurance Co. v. Eric L. Myers, et al., No. CV 10-2024-PHX-JAT, D. Ariz.; 2013 U.S. Dist. LEXIS 18694). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge: Insurer Can Seek Attorney Fees, Post-Judgment Interest BROOKLYN, N.Y. - A life insurer alleging counterclaims of fraud and rescission on a $10 million policy can seek attorney fees and post-judgment interest, a New York federal judge ruled Feb. 4 (Dukes Bridge LLC v. Security Life of Denver Insurance Co., No. 10-CIV-5491, E.D. N.Y.; 2013 U.S. Dist. LEXIS 14931). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Rescission Of Life Insurance Policy Was Proper, Judge Holds TRENTON, N.J. - A New Jersey appeals court on Feb. 14 upheld a grant of summary judgment to a life insurer that denied death benefits based on the insured's misrepresentations on the policy application (Mi Ja Jae v. Metropolitan Life Insurance Co., No. A-2302-11T4, N.J. Super., App. Div.; 2013 N.J. Super. Unpub. LEXIS 340). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' 6th Circuit Upholds Finding Of Misrepresentation CINCINNATI - A lower court that found that an insured lied on an insurance policy application and that the misrepresentation was material did not abuse its discretion, the Sixth Circuit U.S. Court of Appeals ruled Feb. 8 (Chicago Insurance Co. v. James A. Capwill, et al., No. 12-3123, 6th Cir.; 2013 U.S. App. LEXIS 2780). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Judge: Intentional Acts Exclusion Bars Coverage, Judge Rules JACKSON, Miss. - A homeowners insurer that denied coverage for a fire loss based on the policy's intentional acts exclusion acted reasonably, a Mississippi federal judge ruled Feb. 13 (Glenn Lennon, et al. v. Nationwide Property and Casualty Insurance Co., et al., No. 1:11-CV-452-LG-JMR, S.D. Miss.; 2013 U.S. Dist. LEXIS 19302). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' 11th Circuit: Arson Defense Supported By Evidence ATLANTA - An insurer's affirmative defense of arson to a fire loss claim is supported by the evidence, the 11th Circuit U.S. Court of Appeals ruled Feb. 15 (Dennis Quarles, et al. v. Nationwide Property & Casualty Insurance Co., No. 4:09-cv-01338, 11th Cir.; 2013 U.S. App. LEXIS 3248). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Medical Center Agrees To Pay $4.9 Million Under Settlement Agreement BALTIMORE - A hospital in Towson, Md., has reached a settlement with the United States for $4.9 million to settle a dispute under the False Claims Act. The hospital allegedly filed false claims to Medicare and Medicaid and other federal health care programs, according to a Feb. 7 press release from the U.S. Department of Justice. http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=19-9%20Mealey%27s%20Litig.%20Rep.%20Ins.%20Fraud%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' Nursing Center To Pay $700,000 Under Settlement Agreement FAIRFAX, Va. - A nursing center has agreed to pay $700,000 to settle claims with the United States under the False Claims Act. The center allegedly provided therapy treatment that was not medically necessary and then fraudulently billed Medicare for reimbursement, according to a Feb. 13 U.S. Department of Justice press release.