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WARNING: New York Percentage Billing Arrangements Under Attack. Medicaid Frad Unit Is Seeking Recoupment from Providers Using...

New York’s Medicaid Fraud Control Unit (“MFCU”) has sent demand letters seeking recoupment from certain healthcare providers in New York State who have percentage of collection arrangements with their outside billing...more

Second Circuit Affirms Dismissal of FCA Cases

by Jones Day on

The Second Circuit affirmed the dismissal of two False Claims Act ("FCA") cases brought by private relators against insurance and other companies based on the alleged failure to reimburse the Centers for Medicare & Medicaid...more

Navigating Yates Memo Minefield and Broadening of Excess Side-A DIC D&O Insurance Policies

by Perkins Coie on

Former Deputy Attorney General Sally Yates issued a memorandum (the Yates Memo) in September 2015 setting forth guidance on how the U.S. Department of Justice would handle future corporate investigations and, to the extent...more

A Common Interest Agreement May Not Be Worth the Paper It’s Written On

by Wilson Elser on

It is a very common practice for counsel to co-defendants or co-plaintiffs to enter into agreements that shield their communications. The agreements are expressions of intent that the communications will be protected by the...more

Justice Department Joins Whistleblower Suit Accusing UnitedHealth Group of Overcharging Medicare by “Hundreds of Millions”

The U.S. Department of Justice (DOJ) has joined a whistleblower lawsuit, United States of America ex rel Benjamin Poehling v. Unitedhealth Group Inc., No. 16-08697 (Cent. Dist. Cal. Sep. 17, 2010), ECF No. 79, against...more

How to Avoid the Implied Waiver of the Attorney-Client Privilege In Arizona Insurance Bad Faith Cases

by Jaburg Wilk on

In State Farm v. Lee, 199 Ariz. 52, 13 P.3d 1169 (2000) (En Banc), the Arizona Supreme Court first held that an Insurer can impliedly waive the attorney-client privilege (the “Privilege”) in a bad faith case, despite not...more

CGL Coverage for False Advertising and Intellectual Property Claims: Sometimes It’s There, but You Need to Know Where to Look for...

A recent case in the Northern District of California offers two cautionary tales to policyholders. First, when buying insurance, companies should understand their risks and ensure that the policies they’re buying match those...more

Guidelines to Assist an Insurer’s Analysis of Whether a Court Will Find an Implied Waiver of the Attorney Client Privilege in...

by Jaburg Wilk on

Because Arizona cases touching on this issue are copious, confusing, and complex, we note the following guidelines—though sometimes conflicting—have emerged from Lee and its progeny and will assist an Insurer’s analysis of...more

Tips to Avoid the Implied Waiver of the Attorney-Client Privilege in Arizona Insurance Bad Faith Cases

by Jaburg Wilk on

Although Arizona law regarding the implied waiver of the attorney-client privilege (the “Privilege”) is far from certain, an Insurer may avoid a waiver by following these tips...more

Defence & Indemnity - December 2016: V. SURETY AND BOND ISSUES

by Field Law on

Alberta Court of Appeal confirms an obligee/trustee under labour and material payment bond has no legal duty to disclose the existence of such a bond to potential bond claimants until specifically asked about its...more

Retail Hospitality Newsletter - Late Fall 2016

by Reminger Co., LPA on

Sudden cardiac arrest (“SCA”) is the largest cause of natural death in the United Statesand is responsible for approximately half of all heart disease deaths. SCA, however, is not a “heart attack” (i.e. an artery blockage)...more

A Liar and A Cheat? 3 Ways to Pay...

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Insurer gets to pick its remedy when hospital engages in dishonest billing and illegal kickbacks…to the tune of $41 million. Judge Lynn Hughes of the U.S. District Court for the Southern District of...more

Delaware Superior Court Limits Fraud Exclusion

by Morris James LLP on

This is an important decision because it limits the use of the typical fraud exclusion in a D&O policy to avoid liability to the insured. The insured David Murdoch was found to have breached his fiduciary duty to Dole Foods...more

The Ghost of Systems Past: “Big Data” Suits Loom, But Old Data Issues Remain Unresolved

by Carlton Fields on

2017 could be big for litigation over “Big Data” applications in insurance. This past year saw the filing of several “price optimization” class actions, and claims against a fraud detection tool, similar to the ones used by...more

Court Tosses Time-Barred Rico Claims Alleging Captive Reinsurance Kickback Scheme

by Carlton Fields on

Plaintiffs asserted class claims for RICO violations based on allegations that Bank of America referred borrowers to private mortgage insurance providers in exchange for kickbacks, funneled through a captive reinsurance...more

U.S. Supreme Court Rules That Seal Violations Do Not Require Dismissal of Qui Tam False Claims Act Suits

by K&L Gates LLP on

On Tuesday, the Supreme Court issued an anxiously anticipated False Claims Act (“FCA”) decision in State Farm Fire & Casualty Co. v. United States ex rel. Rigsby, holding that a violation of the statute’s seal requirement...more

Supreme Court Rejects Mandatory Dismissal for an FCA Seal Breach

by Bass, Berry & Sims PLC on

The Supreme Court held that a relator’s breach of the seal in a qui tam case does not require mandatory dismissal of the complaint, but the Court declined to articulate what factors are appropriate to consider in determining...more

Supreme Court Holds That Violations of the False Claims Act’s Seal Requirements Do Not Require Automatic Dismissal

On December 6, 2016, the Supreme Court of the United States ruled unanimously in State Farm Fire and Casualty Co. v. United States ex rel. Rigsby that violations of the False Claims Act’s (FCA) seal requirement do not require...more

Ohio Appeals Court Dents Plaintiffs’ Class Certification Motion

by Benesch on

Four independent auto body shops sued Progressive Casualty Insurance Company in state court in Cleveland. Their gripe? They claimed that they repaired Progressive-covered vehicles but that Progressive tortiously interfered...more

The Illinois Supreme Court Opens Door to Claims Against Government Entities for Flood Losses

by Cozen O'Connor on

Floods lead to costly claims for insurance companies. Unfortunately, subrogated insurers are frequently precluded from pursuing governmental entities that cause flooding because they enjoy immunity from tort claims. So, for...more

Product Contamination: Strong Underwriting is Key

by Zelle LLP on

In 2011, the Food Safety Modernization Act, regarded by many as a major reform of the food safety provisions of the Federal Food, Drug and Cosmetic Act, significantly expanded the powers of the U.S. Food and Drug...more

Litigation Alert: The Fifth Circuit Limits Coverage under the Computer Fraud Provision of Insurance Policies

by Fenwick & West LLP on

Last week, the U.S. Court of Appeals for the Fifth Circuit narrowed the conduct covered under an insurance policy’s computer fraud provision by vacating the judgment in favor of the insured, Apache Corp., and rendering...more

AXA Prevails at First Post-Jones v. Harris Excessive Fee Trial

by Carlton Fields on

In its 2010 opinion in Jones v. Harris, L.P., the United States Supreme Court embraced the so-called Gartenberg standard for assessing an investment adviser’s fiduciary liability for excessive mutual fund fees under Section...more

Arizona Court of Appeals Reverses $1 Million Award of Punitive Damages in Insurance Bad Faith Case for Alleged “Institutional Bad...

by Jaburg Wilk on

In Sobieski v. Am. Standard Ins. Co. of Wisconsin, 2016 WL 5436588 (Ariz.App. Sept. 29, 2016), despite upholding a bad faith judgment for an insurer conducting an unreasonable investigation and denying a claim, the Arizona...more

What Standard Governs the Dismissal of a Relator's Claim for Violation of the False Claims Act's Seal Requirement in an Action...

by Pullman & Comley, LLC on

In the aftermath of the destruction caused by Hurricane Katrina in 2005, Cori and Kerri Rigsby accused State Farm Fire and Casualty Company of falsely misclassifying wind damage as flood damage, among other misdeeds, leaving...more

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