News & Analysis as of

Insurance Litigation False Claims Act (FCA)

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

Arnall Golden Gregory LLP

New Administration Continues Focus on Accountability and Transparency in Healthcare

Blockbuster health insurers continue to face scrutiny from the new administration amid an unprecedented shift toward eliminating fraud, waste, and abuse from the healthcare industry....more

Goodwin

Health Headlines: May 2025

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On May 14, 2025, Pennsylvania State Sen. Tim Kearney and State Rep. Lisa Borowski introduced legislation addressing private equity and corporate interests in healthcare. Pennsylvania Gov. Josh Shapiro is touting the companion...more

Rivkin Radler LLP

FCA Case Against Insurers Alleges Kickbacks and Discriminatory Practices

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On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal...more

Carlton Fields

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

Carlton Fields on

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

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

Goodwin

Aetna’s “Fraud Scheme” Lawsuit Against Radiology Group Highlights Health Plans’ Resistance to Private-Equity-Backed Providers

Goodwin on

On December 23, 2024, various Aetna affiliates (referred to hereafter as Aetna) filed suit against Radiology Partners, Inc., a national, private-equity-backed radiology group, alleging that Radiology Partners defrauded the...more

McGuireWoods LLP

Recent Decision from Eastern District of New York Confirms D&O Coverage for False Claims Act Defense Costs

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A recent decision by a federal court in the Eastern District of New York illustrates how directors and officers (“D&O”) policies can provide valuable insurance coverage for defense costs and potential liabilities arising from...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

Wiley Rein LLP

D&O Policy’s Professional Services Exclusion Does not Bar Coverage for False Claims Act Settlement

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The Delaware Supreme Court has held that a professional services exclusion in a D&O policy does not bar coverage for a False Claims Act settlement. In 2017, a former employee of the insured mortgage loan company brought a...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

Bass, Berry & Sims PLC

SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants

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In a decision issued on September 30, Judge Andrew Carter of the U.S. District Court for the Southern District of New York denied Anthem Inc.’s motion to dismiss a government lawsuit filed in March 2020 claiming Anthem...more

Wiley Rein LLP

Written Consent Must be in Writing: Insured Breaches Consent Requirement and Loses Coverage

Wiley Rein LLP on

Applying Georgia law, a federal district court has held that an insured’s failure to seek consent to incur defense costs pursuant to a consent provision relieved the insurer from any obligation to provide coverage for those...more

Carlton Fields

Professional Services Exclusion Precludes Coverage for False Claims Act Suit

Carlton Fields on

It is not unusual for a directors and officers liability policy to have an exclusion for professional services. A such, a question often arises regarding whether the claimed wrongful conduct involved the rendering or failure...more

Carlton Fields

Blowing the Whistle on Willful Misconduct: California Court holds that False Claims Act Suits Are Uninsurable Due to Public Policy

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Willful misconduct is uninsurable. It is a fundamental principle of insurance, and it makes sense to both the lay and the lawyerly. But few states go as far as to codify this principle in the insurance code. California is an...more

Carlton Fields

Federal Court Holds California Insurance Code Bars Duty to Defend Against False Claims Act Violations

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The Central District of California held that Section 533 of the Insurance Code eliminated any potential for coverage for suit under the state False Claims Act. On January 4, the U.S. District Court for the Central...more

Dorsey & Whitney LLP

Fifth Circuit Concludes That FCA Claim Was Not Covered By Insurance Policy

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The U.S. Court of Appeals for the Fifth Circuit recently rejected a shipbuilder’s claim against its insurance company seeking defense and indemnification from a False Claims Act suit. See XL Spec. Ins. Co. v. Bollinger...more

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