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LexisNexis® Mealey's™ Insurance Fraud Legal News
Headline Insurance Fraud Legal News from LexisNexis®

• No 'Good Cause' Shown For Deposition Of State Farm Employee As An Individual
  PHILADELPHIA - Finding that defendant medical providers and others failed to demonstrate any "good cause" for the deposition of an insurance company's corporate designee as an individual and that they had ample opportunity to obtain the information sought in the two prior depositions, a federal judge on Nov. 25 affirmed his prior protective orders for the insurer barring the additional depositions sought (State Farm Mutual Automobile Insurance Co. v. New Horizont Inc., et al., No. 03-6516, E.D. Pa., 2008 U.S. Dist. LEXIS 96411). Full story on lexis.com
• California Attorney, 5 Others Charged With Fraud, Theft
  LOS ANGELES - A California attorney, his brother, two chiropractors and two alleged cappers have been charged with participating in an auto insurance fraud ring that billed insurance companies for medical services that were not performed, the California Insurance Department announced Dec. 11 (The People of the State of California v. Hamid Taghizadeh, et al., No. BA349614, Calif. Super., Los Angeles Co.). Full story on lexis.com
• Bayer HealthCare Settles Kickback Allegations For $97.5 Million
  WASHINGTON, D.C. - Bayer HealthCare LLC has agreed to pay $97.5 million to resolve government allegations arising out of an investigation into the company's marketing of diabetes self-testing supplies from 1998 to 2003, the company and the U.S. Department of Justice announced Nov. 25. Full story on lexis.com
• Florida DME Company Operator Pleads Guilty In $56.7 Million Fraud
  MIAMI - A man who allegedly operated and controlled 13 Florida durable medical equipment (DME) companies and three medical clinics and, along with co-conspirators, used the companies to submit $56.7 million in fraudulent claims to Medicare, pleaded guilty on Nov. 14 to charges of Medicare conspiracy and making false claims upon the United States, according to U.S. Attorney R. Alexander Acosta of the Southern District of Florida (United States v. Miguel Almanza, No. 08-cr-20899, S.D. Fla.). Full story on lexis.com
• 3 Florida Family Members Plead Guilty To $17.3 Million Durable Medical Equipment Fraud
  MIAMI - The husband and wife owners of two Florida durable medical equipment companies and the man's brother pleaded guilty on Nov. 13 to conspiracy to commit health care fraud and other charges related to a scheme to fraudulently bill Medicare for approximately $17.3 million (United States v. David Hernandez, et al., No. 08-cr-20634, S.D. Fla.). Full story on lexis.com
• Miami Clinic Owners, 2 Others Sentenced In Massive HIV Infusion Fraud
  MIAMI - The owners of two Miami HIV clinics and two people who allegedly helped launder the money from a multimillion dollar HIV infusion fraud scheme have been sentenced in the U.S. District Court for the Southern District of Florida. Full story on lexis.com
• California Hospital Executive Pleads Guilty To Paying Kickbacks To Homeless
  LOS ANGELES - The chief executive officer of City of Angels Medical Center has pleaded guilty to charges of paying kickbacks for patient referrals as part of a scheme to recruit homeless Medicare and Medi-Cal beneficiaries, provide them with unnecessary medical services and fraudulently bill the programs for the unnecessary services and services that were not provided, U.S. Attorney Thomas P. O'Brien announced Dec. 12 (United States of America v. Rudra Sabaratnam, et al., No. 2:08-CR-00904, C.D. Calif.; See August 2008, Page 16). Full story on lexis.com
• Judge Dismisses Suit Against Filipino Doctor Based On Delay In Arrest
  MADISON, Wis. - A federal judge on Nov. 17 dismissed the charges against a Filipino physician accused of defrauding TRICARE after finding that the U.S. government violated his right to a speedy trial by failing to take prompt steps to arrest him while he was living in the Philippines (United States v. Diogenes A. Dionisio, No. 04-CR-30-BBC, W.D. Wis.; 2008 U.S. Dist. LEXIS 84453; See November 2008, Page 14). Full story on lexis.com
• Panel: Issues Of Fact Exist On Whether Insurer Satisfied Its Underwriting Duty
  LOS ANGELES - A trier of fact reasonably could conclude that an insurer failed to satisfy its duty to "complete medical underwriting" under California Health and Safety Code Section 1389.3 and therefore could not rescind the plan contract unless the insured's misrepresentations or omissions were willful, a California appeals panel found Nov. 18, reversing a lower court's grant of summary judgment in favor of the insurer on claims for breach of contract, bad faith and punitive damages (Christiane Callil v. California Physicians' Service, No. B203085, Calif. App., 2nd Dist., Div. 4; 2008 Cal. App. Unpub. LEXIS 8957). Full story on lexis.com