Insurance Fraud

News & Analysis as of

New Jersey Supreme Court Holds that a Person Violates the Insurance Fraud Statute Even if Insurer is Not Duped Into Paying a...

In the recent case of State of New Jersey v. Robert Goodwin, 224 N.J. 102, 129 A.3d 316 (N.J. 2016), the Supreme Court of New Jersey held that a person violates the insurance fraud statute, N.J.S.A. 2C:21-4.6(a), even if he...more

Two Federal Courts Uphold Criminal Convictions for Insurance Brokers

Two federal appellate decisions highlight the potential criminal liability for rogue agents. First, in United States v. Binday, the Second Circuit Court of Appeals upheld mail and wire fraud convictions of three individuals...more

Jury Awards Aetna $37.4M in Medical Billing Fraud Case

A California jury in Aetna Life Insurance Company v. Bay Area Surgical Management LLC, et al., 1-12-CV-217943 (Superior Court of Santa Clara County), unanimously awarded Aetna Inc. over $37.4 million in damages, finding that...more

Important Court Decision For No-Fault Insurers -- Federal Court Rejects Argument To Limit Insurers’ Right To Seek Judicial Relief...

We are pleased to inform you of a very favorable recent caselaw development in the no-fault insurance area, in which our firm played a significant role. Specifically, on March 24, 2016, in the case of Liberty Mutual Fire...more

New Law in New Jersey Increases Scope of Insurance Fraud to Insurance Certificates

Contractors should be aware of a New Jersey law that could cause them to be found liable for insurance fraud if they provide insurance certificates to owners containing false or misleading information. The new law, which goes...more

Penalty Declined – Party Escapes Summary Judgment Despite Evasive Discovery Responses

On February 17, 2016, the Court of Appeal for the Fourth Appellate District in People ex rel. Government Employees Insurance Company (“GEICO”) v. Cruz (Court of Appeal D067061, Superior Court Case 37-2013-00029878),...more

UK Financial Regulatory Developments - January 2016 #9

FCA updates IPRU-INV, FC and EG - FCA is updating its Handbook on its website to convert the Interim Prudential sourcebook for Investment Businesses (IPRU-INV), the Financial Crime Guide (FC) and the Enforcement Guide...more

Blog: UK Insurance Fraud Taskforce Produces Its Final Report

In January 2016 the Insurance Fraud Taskforce produced its final report into the serious issue of fraud in insurance, a problem which is reported to cost more than £3bn each year. The proposals made in the report are...more

Fraudulent Auto Accident Claims Cost Consumers

Dishonest motorists, passengers and pedestrians are involved in numerous auto accidents each year, and while actual damages from these accidents may be insignificant, these scammers make fraudulent claims for nonexistent...more

Tribunal fines insurance broker for mishandling client moneys

The Tribunal has fined former insurance broker Terence Joint £10,000 for failings in relation to the handling of client money. Due to personal circumstances Mr Joint became disconnected from the day-to-day running of the...more

A New Arrow in the Quiver for Physicians Facing Dual Civil and Criminal Fraud Investigations

At a time when doctors face increased pressure from competition, reduced fee schedules, and greater scrutiny from insurance company Special Investigative Units (“SIUs”) and State Office of Insurance Fraud Prosecutors...more

Health Care Physicians in the Crosshairs: Criminal Prosecution

Recent changes to our health care system have been at the forefront of the American news cycle for several years. But certain aspects have not received adequate attention. One example is the scrutiny federal and state...more

Twitter Ordered by Irish Court to Disclose Information about Author of Tweet

Twitter International Company (TIC) in Dublin, Ireland was reportedly ordered by a High Court to disclose data about the source of tweets about a whistleblower. The tweets, which included allegations of insurance fraud, are...more

Texas Property Insurers Consider Changes to Hail Policies

Texas is in the midst of a hail lawsuit crisis. Tens of thousands of lawsuits have been filed across the state, with dozens more being filed every day. Many of the lawsuits involve meritless claims solicited by case-runners...more

Insurance Fraud Act Suits by Insurers Held to Trigger Right to Jury Trials in New Jersey

Last week, the New Jersey Supreme Court unanimously held that a civil defendant sued by an insurance company for violations of the state’s Insurance Fraud Prevention Act (IFPA) has the right to trial by jury. In Allstate New...more

Courts Say There’s No Claim for “Reverse Bad Faith.” Could They Be Wrong?

Last month, in State Auto Property & Casualty Ins. Co. v. Hargis, No. 13-5020 (6th Cir. May 6, 2015), the U.S. Court of Appeals for the Sixth Circuit predicted that the Kentucky Supreme Court would not allow insurers to sue...more

Sixth Circuit Refuses to Create a Cause of Action for Reverse Bad Faith

In an opinion handed down last week, the Sixth Circuit Court of Appeals refused to adopt a new cause of action under Kentucky law for a reverse bad faith claim by an insurer against its insured where the Kentucky Supreme...more

California State Court Holds that Date Insurer Refers Insurance Claim to Government Triggers IFPA’s Statute of Limitations

Last week, a Los Angeles Superior Court held that the relevant date for determining when the statute of limitations begins to run under the Insurance Frauds Prevention Act (IFPA) is the date an insurer forms a reasonable...more

Staged car crashes claim many victims

Many drivers throughout Chicago have become victims of fraudulent auto accident claims, which are a common way for organized crime rings to make money. Drivers are often unaware of the fraud, and quietly accept their role in...more

Los Angeles County Sues Hospital Owner for False Surgical Implant Claims to County Workers’ Compensation Program

On July 18, 2014, the County of Los Angeles (“the County”) filed a lawsuit in Los Angeles Superior Court again Michael D. Drobot, Sr., his son Michael R. Drobot, Jr. and their controlled entities, Pacific Hospital of Long...more

Automobile Insurance Fraud and How to Protect Yourself

Fraud occurs when an individual knowingly and intentionally lies to obtain a benefit or advantage to which he/she is not actually entitled or when an individual knowingly and intentionally denies a benefit to someone who is...more

Favorable Secondary Life Market Report By Florida Regulator

The Florida Office of Insurance Regulation recently issued an opinion favorable to the insurance industry in its Secondary Life Insurance Market Report. Responding to a Florida Legislature directive, the OIR conducted a...more

"Loss Payee" v. "Lender Loss Payee": How the Difference of One Word Can Prevent a Secured Lender's Recovery on Insurance Proceeds

As a secured lender, you take a security interest in your borrower’s inventory and/or equipment and then perfect under applicable law. To further protect the value of the collateral supporting your loan, you confirm your...more

Drug Manufacturer’s Liability Under Insurance Frauds Prevention Act May Not Be Inferred From Alleged Kickbacks to Physicians

Three former employees of Bristol Myers Squibb, Inc. (BMS) brought a qui tam action alleging that BMS violated California’s Insurance Frauds Prevention Act, California Insurance Code section 1871.7 et seq. (IFPA), by giving...more

OIG Publishes Audit of Outpatient Therapy Services Seeking Return of $3.1 Million in Reimbursements

In June 2013, the Department of Health and Human Services, Office of Investigator General (OIG) published a review of its audit of an outpatient therapy services provider. The OIG concluded that the outpatient therapy...more

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