Data Driven Compliance: The Failure to Prevent Fraud Offense: Insights for US General Counsels with Mike DeBernardis
The State of Healthcare Enforcement
Daily Compliance News: August 21, 2025, The Fabricated Evidence Edition
Data Driven Compliance – James Tillen on the Importance of Cross-Functional Collaboration in Complying with the FTPF Offense
2 Gurus Talk Compliance: Episode 57 — The Tom on His Highhorse Edition
Data Driven Compliance: Understanding the ECCTA and Its Impact with Jonathan Armstrong
10 For 10: Top Compliance Stories For the Week Ending, August 2, 2025
Data Driven Compliance: Understanding the ECCTA and Its Impact on Fraud Prevention with Vince Walden
Everything Compliance: Episode 158, The No to Corruption in Ukraine Edition
Daily Compliance News: July 31, 2025. The Forgotten Generation Edition
Understanding BBB Ratings: Building Trust and Mitigating Risks — Regulatory Oversight Podcast
Episode 379 -- Update on False Claims Act and Customs Evasion Liability
Data Driven Compliance: Understanding the UK’s New Failure to Prevent Fraud Offense with Sam Tate
Everything Compliance: Episode 157, The Q2 2025 Great Women in Compliance Edition
Daily Compliance News: July 22, 2025, The I-9 Hell Edition
Compliance Tip of the Day: Avoiding CCO Liability
2 Gurus Talk Compliance: Episode 55 – The From Worse to Worser Edition
Daily Compliance News: July 17, 2025, The COSO Yanked Edition
Wire Fraud Litigants Beware: Fourth Circuit Ruling Protects the Banks — The Consumer Finance Podcast
Compliance into the Weeds: Agentic Misalignment and AI Ethics: Analyzing AI Behavior Under Pressure
Introduction: Understanding Fidelity Investigations - Fidelity / Crime / Financial Institution Bonds, in a general sense, cover an insured from the willful theft of property, money, and securities by one of their employees...more
Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more
Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more
Schnatzmeyer v. State Farm Ins. Co., No. 3:23-CV-02820-K, 2025 WL 1697505, at *1 (N.D. Tex. June 17, 2025). In a case involving two overlapping freeze claims—and a substantial array of legal issues affecting insurers in...more
If you’ve received a settlement check from an insurance company after a car accident, property damage claim, or injury settlement, you might be wondering: how long is an insurance check good for? While holding onto it for a...more
Increasing abuses in the claims process have caused insurance companies to rethink the traditional model of sending out cash to pay claims. Far too often, that cash is used for purposes other than fixing damage, with a...more
Recently, Pennsylvania Governor Josh Shapiro announced that he launched a new centralized consumer protection hotline, website and email address to assist Pennsylvanians in reporting scams and resolving financial and...more
As a part of our Quarterly Practice Group Update, we are pleased to produce another installment with examples of our continued success in the area of fraud litigation. The New York State Workers’ Compensation Board has...more
Surprised insurers are unhappy insurers. And unhappy insurers are more likely to resist paying claims. As are insurers who fail to heed their good faith and other obligations to their policyholders. So if you seek coverage...more
In a win for Wiley’s client, a New Jersey appellate court, applying New Jersey law, affirmed a trial court’s decision rescinding four lawyer’s professional liability policies because of material misrepresentations made in the...more
The United States District Court for the Central District of California, applying California law, has held that a lending exclusion in a bankers professional liability policy barred coverage for underlying lawsuits alleging...more
Universal Property & Casualty Insurance Company v. Luis Nacimiento, Fla. 3rd DCA, 3D23-0301, Apr. 3, 2024 - The insured reported a claim to Universal Casualty & Property Insurance Company in February 2016 for water damage...more
Artificial Intelligence (AI) is the simulation of human intelligence processes by machines, such as computer systems for assistance in quickly answering complicated questions, researching a specific topic, or creating an...more
Car insurance plays a crucial role in protecting drivers and their finances after an accident. It provides financial support for medical bills, lost wages, and car repairs. However, a recent Michigan Supreme Court decision in...more
A judge from the District of Colorado recently issued an opinion that might leave the door open for long-term care insurers to void policies after the contestability period expires if an insured commits fraud. See Meyer v....more
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
GEICO filed a complaint against a series of medical providers asserting claims under the New Jersey Insurance Fraud Prevention Act (IFPA), violations of RICO, common law fraud and unjust enrichment. Some of the medical...more
In Abbas v Esurance Insurance Company of Canada, 2023 ABCA 36 [Abbas], the Alberta Court of Appeal endorsed what it described as draconian consequences for insurance fraud as consistent with the Insurance Act, RSA 2000 c I-3...more
Following the easing of Covid pandemic restrictions, we are now facing a fresh “cost of living crisis” created by rising inflation and soaring energy bills. The Guardian newspaper reported that forecourts at petrol...more
Insurance claims for employee losses are generally examined by insurance carriers. The carrier will often retain a forensic accountant who has the ability to measure employee losses. Employee losses are typically categorized...more
In SJ Computers LLC v. Travelers Casualty and Surety Company of America, the U.S. District Court for the District of Minnesota recently addressed the scope of insurance available for a phishing scheme under the terms of a...more
Insurance claims for loss of inventory are generally examined by insurance carriers. The carrier will retain a forensic accountant who has the ability to quantify out of sight inventory losses. Out of sight inventory losses...more
Causation, an issue courts often wrestle with when deciding insurance coverage issues, lands the starring role in our February Insurance Update. •A county experienced higher costs due to the opioid crisis. Does its...more
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
An insured applies for a life insurance policy, answering “no” to all medical and health-related questions. She dies within two years of her application, and the insurer discovers she was in fact diagnosed with cancer two...more