News & Analysis as of

False Claims Act (FCA) Insurance Claims

Wiley Rein LLP

No Second Bite at the Apple: New Emails Can’t Undo a False Application Response

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The United States District Court for the Central District of California, applying California law, has held that an insurer could rescind liability insurance policies based on misrepresentations in the application, even though...more

Carlton Fields

Florida Appeals Court Decisions Week of April 14 - 18, 2025

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U.S. Eleventh Circuit Court of Appeals - Kinsale v. Pride of St Lucie - (Fla law) insurance, bad faith, duty to initiate settlement - Pipkins v. Hoover Ala - Fourth Amendment, deadly force - Vargas v. Lincare - False...more

Troutman Pepper Locke

Massachusetts AG Indicts Health Care Providers and Owners for Submission of Allegedly False Medicaid Claims

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The Office of Massachusetts Attorney General (AG) Andrea Campbell announced the criminal indictment of several Massachusetts-based health care providers and their owners in connection with allegedly false claims they...more

Marshall Dennehey

Reimbursement of Pennsylvania Department of Human Services Lien Is Found Not Automatic by Pennsylvania Commonwealth Court

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Key Points: No formal liability for payment of work-related medical expenses is triggered on the part of the employer/insurer until such expenses are properly submitted in accordance with the terms and provisions of the...more

Laughlin, Falbo, Levy & Moresi LLP

A NEW MEDIC-ERA; Changes to CMS Review Guidelines in 2025

Vast changes are swiftly approaching regarding the efforts Workers’ Compensation practitioners must make in protecting Medicare’s interests in future medical settlements. The Centers for Medicare/Medicaid Services (CMS) has...more

Rivkin Radler LLP

NJ LCSW Pleads Guilty to Defrauding Private Health Insurers for Years

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The owner of Bergen Alliance Counseling Services in Paramus, New Jersey pleaded guilty to a run-of-the-mill healthcare fraud scheme in District Court in Newark on March 19. Maria Cosentino of Garfield, a licensed clinical...more

Bradley Arant Boult Cummings LLP

The Haunting in the Cornfield: Relators’ Qui Tam Claim Confirmed Dead by the Eighth Circuit

The Eighth Circuit Court of Appeals recently affirmed judgment against relators in a case alleging that a group of dairy farmers growing corn violated the False Claims Act by filing false insurance claims paid by the Federal...more

Rivkin Radler LLP

Insurance Update - October 23, 2023

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Here’s what we discuss in our October Insurance Update. Illinois: Environmental Suits Alleging Non-Compliance with Laws and Regulations Did Not Assert an “Occurrence”- Massachusetts (federal): Insurer May Consider Sums...more

Carlton Fields

7th Cir. Holds Insurance Coverage Applies to Settlement Payments for Alleged Anti-Kickback and False Claims Act Violations

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On May 3, 2023, the Seventh Circuit Court of Appeals, in Astellas US Holding Inc. v. Federal Insurance Co., held that a liability insurer was required to contribute its limits toward its insured’s payment to settle potential...more

Rivkin Radler LLP

Insurance Update - May 2023

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Additional insured disputes can sometimes get complicated. How much coverage the additional insured gets is often a hotly contested issue, especially when the named insured has coverage above the minimum limits it promised...more

Lowenstein Sandler LLP

In the Know: The Lowenstein Insurance Recovery Group’s Tip of the Month - October 2021

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A recent coverage case from Illinois is a helpful reminder to policyholders that they should not take no for an answer when insurers deny a claim based on uninsurability, restitution, disgorgement, or fraud. In fact, those...more

Rivkin Radler LLP

Insurance Update - October 2021

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Here’s our October Insurance Update. The Sixth Circuit had insurance on its mind this past month. Three of the decisions we discuss in our update are from that court. First, the Sixth Circuit joins the Eighth and...more

King & Spalding

Recent Court Ruling Illustrates The Perils Insurers Face When Sending Boilerplate Coverage Letters To Georgia Policyholders

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Federal Court in Georgia Applies Hoover Rule Finding that Insurers Who Sent Denial Letters Waived Right to Assert Other Coverage Defenses Later. Eight years ago in Hoover v. Maxum Indemnity Co., 730 S.E.2d 413 (Ga. 2012),...more

Morrison & Foerster LLP

COVID 19 – Business Interruption Insurance Test Case

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The High Court’s recent judgment[1] in a test case brought by the Financial Conduct Authority (“FCA”) in relation to certain non-damage business interruption (“BI”) insurance policies found that most (but not all) of the...more

Seyfarth Shaw LLP

California’s Insurance Frauds Prevention Act Allows Insurer-Whistleblowers To Sue Defendants For Fraudulent Claims Presented To...

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I. INTRODUCTION - Insurance fraud - whether in the auto, workers’ compensation, or health insurance arenas - is an enormous and costly national problem.  It hurts policyholders who have to pay increased premiums to offset...more

Seyfarth Shaw LLP

Fraud In Your Healthcare Plan? It’s Probably There

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Seyfarth Synopsis: Employer subsidized healthcare is one of the largest cost centers for small and large businesses.  This post provides a primer on what to do if you suspect that your healthcare costs are rising because your...more

Carlton Fields

Court Finds No Coverage for $42 Million False Claims Act Suit Due To Late Reporting

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A federal court has found no coverage for a $42 million whistleblower settlement due to the insured’s failure to timely report the claim to its carrier. PAMC, Ltd. v. National Union Fire Insurance Company of Pittsburgh, Pa.,...more

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