Criminal Law, Insurance

There is No Coverage for Fighting in Alaska, Seriously

by Smita Mokshagundam | Sedgwick LLP on 5/20/2013

Late last month, the Supreme Court of Alaska affirmed the lower court’s decision in favor of an insurance company that denied coverage to insured, Kent Bearden, for liability in a civil suit filed by the victim of his...more

Insurance Coverage for Cyber Attacks

by Roberta Anderson | K&L Gates LLP on 5/8/2013

There’s no denying that the present-day Internet, while extraordinary, is increasingly scary. Cyber attacks of various types continue to escalate across the globe. As stated by one recent commentator: “Cybercrime is raging...more

Liability Insurers May Have Duty to Defend Against Federal Prosecutions, California Court of Appeal Holds

by James Hazlehurst | Barger & Wolen on 5/7/2013

The Second Appellate District of California held on May 1 in Mt. Hawley Ins. Co. v. Lopez that California Insurance Code section 533.5(b) does not eliminate a liability insurer’s duty to defend against a federal prosecution...more

DOES AUTHORITY EXIST FOR CRIMINAL PROSECUTION FOR VIOLATIONS OF BAIL LICENSING LAWS WITHOUT CERTIFICATION OF CRIMES BY THE...

by Bonnie Merrick on 5/6/2013

California attorney Joseph Cavallo was convicted of violating Title 10, CCR section 2071, "recommendation of attorney by bail licensee". The authority to prosecute violations of the bail licensing regulations lies with the...more

Fourth Circuit Court Of Appeals Puts Teeth Into The "In Fact" Exclusions Of A D&O Policy

by Steven Brodie, Joseph Lang Jr., Sylvia H. Walbolt | Carlton Fields on 4/24/2013

In Farkas v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA, No. 12-1481, 2013 WL 1459248 (4th Cir. Apr 11, 2013), the Fourth Circuit Court of Appeals affirmed a decision that put teeth into the "in fact" exclusions of a...more

Arrests Made and Investigation Underway at a Chicago Hospital

by King & Spalding on 4/23/2013

On April 16, 2013, the United States Department of Justice (DOJ) and U.S. Attorney’s Office in the Northern District of Illinois announced the arrest in Chicago of the owner and senior executive of Sacred Heart Hospital...more

Loan Originator Compensation: New Rules

by Jonathan Foxx on 4/3/2013

On January 24, 2013, as the last of the Final Rules of the Consumer Financial Protection Bureau (CFPB) rolled out, I offered an outline of all of them, entitled "CFPB's Gang of Seven (Final Rules)".* I listed them in...more

Service of Subpoenas on Syracuse University Seeking Evidence of Sexual Molestation is a “Claim” Giving Rise to Covered Defense...

by Richard Mason | Cozen O'Connor on 3/21/2013

In Syracuse University v. National Union Fire Insurance of Pittsburgh, PA, No. 2012EF 63 (Sup. Ct., Onondaga County, January 29, 2013), the New York Supreme Court, County of Onondaga, held that an insured’s costs incurred in...more

Looking Back on Appeals That Made a Difference

by Thomas Newman | Duane Morris LLP on 3/8/2013

Originally published in the New York Law Journal on March 6, 2013. Almost 50 years have elapsed between my first and most recent appearance before the New York Court of Appeals and a recent LEXIS search shows I...more

Wager, Insurance, Bucketing or Swap?

by Keith Paul Bishop | Allen Matkins Leck Gamble Mallory & Natsis... on 3/5/2013

In yesterday’s post, I mentioned Professor Joan Heminway’s recent essay on crowdfunding. She notes that some crowd funding arrangements may “may look less like investment instruments commonly known as common stock or...more

Health Care Enforcement in 2012: A Year in Review

by Hope Foster, Samantha Kingsbury, Tracy Miner, Jessica Sergi, Stephanie Willis | Mintz Levin - Health Law on 2/26/2013

Last year was another busy year in health care fraud enforcement. In 2012, the Office of Inspector General for the Department of Health and Human Services (HHS-OIG) reported total expected recoveries of $6.9 billion from all...more

Too Big to Exclude; Too Much Wrongdoing to Ignore

by Melissa Brown, Robert Wolin | BakerHostetler on 2/26/2013

A 2007 audit initiated by a Medicare Program Safeguard Contractor (PSC) discovered that a North Carolina provider had a high incidence of inpatient billings for patients who did not stay in the hospital overnight. The PSC's...more

Protecting Your Hospital From Over-Utilization Prosecutions

by Michael Volkov on 2/22/2013

The government has been increasing its focus on healthcare fraud involving “quality” of care. This is an extremely difficult issue, especially for prosecutors. It is very difficult to define “quality” standards and then...more

Expect Increased Medicare Denials for Incarcerated Beneficiaries and Unlawful Aliens

by Leslie Demaree Goldsmith | Ober|Kaler on 2/22/2013

The Department of Health and Human Services’ Office of Inspector General (OIG) recently published two reports finding Medicare improperly paid providers millions of dollars for incarcerated beneficiaries and unlawful aliens...more

Contest insurance, part one: Get it or regret it

by Thompson Coburn LLP on 2/20/2013

Recently I have helped several clients with contests that seemingly required entrants to do the impossible to win a prize. One promotion required contestants to guess a six-digit code that would open a safe. Another involved...more

Hospitals And Fraud Enforcement

by Michael Volkov on 2/19/2013

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

10 Fraud and Abuse Enforcement Trends You Can't Afford to Ignore in 2013

by Cory Fox, Gregory Saikin | BakerHostetler on 2/15/2013

To paraphrase a famous quote, "Those who do not learn from history are doomed to repeat it," and providers who ignore the significance of the federal government's healthcare fraud enforcements efforts in 2012 do so at their...more

Judge Approves Two-Year Delayed Prosecution of WakeMed

by King & Spalding on 2/14/2013

A Federal district court judge issued a February 8, 2013 order granting a delayed prosecution against Raleigh, NC-based WakeMed Health and Hospitals for allegedly submitting false inpatient bills to Medicare. The...more

False Claims Act - Health System Settles Allegations Related To Payments To Physician Advisors

by BakerHostetler on 2/14/2013

The U.S. Department of Justice (DOJ) recently issued a press release related to a settlement agreement between the U.S. Attorney's Office for the District of New Jersey, the state of New Jersey and the Cooper Health System...more

DOJ Brings Civil Fraud Action Against S&P

by Orrick - Structured Finance Group on 2/11/2013

On February 4, the Department of Justice filed a complaint in the Central District of California against two Standard & Poor’s entities in connection with credit ratings S&P provided for certain RMBS and CDOs....more

Two California Appellate Court Decisions Vacate Forfeiture of Bail Bonds

by Samuel Sorich | Barger & Wolen on 2/7/2013

Two recent decisions by California Courts of Appeal reversed trial court rulings which denied surety company motions to vacate the forfeiture of bail bonds....more

California Gets Tough on Healthcare Fraud and Abuse: Are You Protected?

by Matthew Chayt | Nossaman LLP on 1/31/2013

The industry should take note of new California anti-fraud laws that have recently gone into effect—and the increasing challenges of compliance in a rapidly transforming industry. Even as lawmakers in Sacramento debate how...more

When Will They Learn? Doctors Continue to Face Antitrust Charges for Jointly Negotiating Contracts without Clinical or Financial...

by Jonathan Lewis | BakerHostetler on 1/29/2013

Legitimate joint marketing and selling arrangements have the potential to produce efficiencies. This is particularly so, for example, where the arrangement enables the participants to make or market products that they could...more

Fraud: Skilled Nursing Facilities And Nursing Homes

by Michael Volkov on 1/7/2013

When it comes to healthcare fraud enforcement, the government knows how to target its resources. It is estimated that at least 25 percent of all claims paid by Medicare are improper. The government understands the...more

The Allianz FCPA Enforcement Action – What the Compliance Practitioner Needs to Know

by Thomas Fox on 1/2/2013

Who is your favorite character from the Iliad? Is it Agamemnon the king who brings the Greek Armada to Troy for his brother’s honor; perhaps Ajax the mountain of a man who is the most loyal Greek warrior; how about Achilles...more

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