32 results for 'cat:"Fraud" AND cat:"Health Care"'.
J. Gershon dismisses, with prejudice, a third-amended False Claims Act suit against the maker of durable medical equipment and two health care providers alleging they submitted fraudulent reimbursement claims to Medicare and Medicaid. The relators fail to allege they were the original sources of the information at the heart of their case and thus fail to meet the law’s original source exception.
Court: USDC Eastern District of New York, Judge: Gershon, Filed On: April 30, 2024, Case #: 1:18cv2600, NOS: False Claims Act - Torts - Personal Injury, Categories: fraud, health Care, False Claims
J. Dever grants a hospice care company’s motion to dismiss False Claims Act (FCA) allegations brought by a former home hospice case manager. The manager claims the company committed Medicare fraud by falsely reporting hospice patients’ medical conditions in order to recertify them. However, as this is a qui tam claim and other managers already initiated similar actions previously, the FCA’s first-to-file rule applies and the manager’s suit is barred.
Court: USDC Eastern District of North Carolina, Judge: Dever, Filed On: April 10, 2024, Case #: 7:20cv90, NOS: False Claims Act - Torts - Personal Injury, Categories: fraud, health Care, Medicare
Want access to unlimited case records and advanced research tools? Create your free CasePortal account now. No credit card required to register.
Try CasePortal for Free
J. Kness grants a pharmacy chain’s motion to dismiss the government’s joint complaint and intervention, but denies the pharmacy chain’s motion to dismiss the relators’ third amended complaint. This suit involves the pharmacy chain’s alleged attempt to garner Medicare and Medicaid kickbacks by inducing Cook County patients to fill their prescriptions at one of its specialty pharmacy locations. The court finds the government’s intervention does not allege a proper theory of False Claims Act liability, but that the relators’ amended complaint does.
Court: USDC Northern District of Illinois, Judge: Kness, Filed On: March 29, 2024, Case #: 1:14cv1558, NOS: False Claims Act - Torts - Personal Injury, Categories: fraud, health Care, False Claims
J. Chang partially grants a genetic screening company’s motion to dismiss fraud and negligence claims brought by a couple who used its services before having a child. The couple used the company’s prenatal genetic screening test to check if their child would have Down syndrome, and though the test returned a negative result, their child with born with Down syndrome anyway. The court dismisses the couple’s negligence claim against the company but allows their fraud claims to move forward.
Court: USDC Northern District of Illinois, Judge: Chang, Filed On: March 25, 2024, Case #: 1:21cv3085, NOS: Other Personal Injury - Torts - Personal Injury, Categories: fraud, health Care, Negligence
J. Boardman grants a biotechnology firm’s motion to dismiss this RICO and fraud lawsuit that alleges the maker funneled kickbacks to pharmacies who referred patients to expensive medical services for patients with pulmonary arterial hypertension. United Healthcare has not plausibly alleged the scheme continued after January 2014, failed to plead the indirect purchasing rule and its mail and wire fraud allegations are not pleaded in detail. Therefore, the claims are time-barred and dismissed with prejudice.
Court: USDC Maryland, Judge: Boardman, Filed On: March 25, 2024, Case #: 8:22cv2948, NOS: Racketeer Influenced and Corrupt Organizations (RICO) - Other Suits, Categories: fraud, health Care, Racketeering
J. Rutherford denies, in part, United Health's motion for sanctions against an executive in its healthcare fraud case. Although the executive failed to take steps to preserve certain data, he did not act in bad faith.
Court: USDC Northern District of Texas , Judge: Rutherford, Filed On: March 21, 2024, Case #: 3:21cv1547, NOS: Other Fraud - Torts - Personal Property, Categories: fraud, health Care, Sanctions
J. Reidinger grants default judgment in favor of an insurance underwriting company after a client defrauded Medicare, violating a policy the company financed. The client, a clinical laboratory firm, knowingly submitted false claims to Medicare. Therefore, the policy between the company and firm is null and the company is free from indemnifying the firm.
Court: USDC Western District of North Carolina, Judge: Reidinger, Filed On: March 18, 2024, Case #: 1:20cv41, NOS: Insurance - Contract, Categories: fraud, health Care, Insurance
J. DeGravelles grants a request by an ophthalmology practice to dismiss a retina specialist’s fraud claim for lack of detail. The physician is given more time to address deficiencies in his complaint. His fraud claim is based on the practice’s alleged misrepresentation that the business was relatively debt-free during their contract negotiations. The doctor’s fraud claim may be reasserted on amounts he may be owed that are found in the discovery.
Court: USDC Middle District of Louisiana, Judge: DeGravelles, Filed On: March 4, 2024, Case #: 3:22cv3158, NOS: Other Contract - Contract, Categories: fraud, health Care, Discovery
J. Sargus grants, in part, the polypropylene surgical mesh manufacturer's motion for summary judgment, ruling the patient's failure to warn product liability claim fails because the surgeon who performed the mesh implant surgery admits he did not read any of the literature provided with the product and would not have relied on any of the information in making his recommendation for surgery. Additionally, this failure by the surgeon prevents the patient from proving his fraud and fraudulent concealment claims against the manufacturer, which will also be dismissed.
Court: USDC Southern District of Ohio, Judge: Sargus, Filed On: February 1, 2024, Case #: 2:18cv1440, NOS: Personal Injury - Health Care/Pharmaceutical Personal Injury/Product Liability - Torts - Personal Injury, Categories: fraud, health Care, Product Liability
J. Alonso partially grants a physical therapy provider’s motion to dismiss RICO claims brought by two former patients. The patients claim the provider charged them the “full, rack-rate cost of services, instead of the insurance-negotiated rates they are contractually obligated to charge.” The court finds the patients have not sufficiently alleged racketeering claims or Illinois law fraud claims. One of the patient’s additional claims under the Maryland Consumer Protection Act stands, as do both patients unjust enrichment claims.
Court: USDC Northern District of Illinois, Judge: Alonso, Filed On: January 26, 2024, Case #: 1:22cv1181, NOS: Racketeer Influenced and Corrupt Organizations (RICO) - Other Suits, Categories: fraud, health Care, Racketeering
J. Burroughs denies a laser technology seller’s motion to dismiss claims brought against it by a medical cosmetic and gynecology company and its founder for allegedly fraudulently representing one of the seller’s laser products, which was intended to be used for hair removal and skin improvement, such as reducing wrinkles, but was difficult to use and not suited for use on all skin colors. The seller’s motion requires interpretation of its purchase agreement but it is unclear if the company and its founder received the full purchase agreement.
Court: USDC Massachusetts, Judge: Burroughs, Filed On: January 23, 2024, Case #: 1:23cv10967, NOS: Other Contract - Contract, Categories: fraud, health Care, Consumer Law
J. Dever grants the federal government’s motion to dismiss counterclaims brought by a doctor accused of committing medical billing fraud. In previous litigation, the parties agreed to a consent judgment that stipulates the doctor will pay back $5.5 million from his fraudulent activities. Presently, the doctor countersues the governments, claiming that he and his wife have not failed to disclose assets or income and that the consent judgment should be stricken and nullified. The doctor’s argument that the federal government did not timely file its claims is incorrect, and the government is correct in its argument that the previous litigation is sound and final under res judicata.
Court: USDC Eastern District of North Carolina, Judge: Dever, Filed On: December 8, 2023, Case #: 5:22cv140, NOS: All Other Real Property - Real Property, Categories: fraud, Government, health Care
J. Daniel denies a group of medical care providers’ motions to dismiss allegations that they submitted false claims to private insurance companies and government payors. The federal and Illinois governments claim the providers gave people seeking Covid-19 testing in 2020 a superfluous round of testing for unrelated illnesses, passed the costs on to insurers, and then raked in as much as $3.6 million of inflated reimbursements. The court finds the government has sufficiently alleged these allegations for fraud and false claims.
Court: USDC Northern District of Illinois, Judge: Daniel, Filed On: November 27, 2023, Case #: 1:21cv2544, NOS: Other Statutory Actions - Other Suits, Categories: fraud, health Care, Insurance
J. Van Tine finds that the lower court improperly dismissed a woman's consumer fraud claims against her dentist. The Consumer Fraud Act does not bar causes of action arising from the provision of dental services, and the woman can arguably allege that billing her to complete work on a tooth the dentist had already drilled into was dental malpractice. Reversed.
Court: Illinois Appellate Court, Judge: Van Tine, Filed On: November 22, 2023, Case #: 221703, Categories: fraud, health Care, Consumer Law
J. Duncan finds the district court properly dismissed RICO claims filed against the medical society that published guidelines for treating Lyme disease in a peer-reviewed medical journal that certain infected persons say harmed them by bringing into question whether the condition exists. The statements at issue are non-actionable opinions and cannot support a claim for fraudulent misrepresentation. Affirmed.
Court: 5th Circuit, Judge: Duncan , Filed On: November 16, 2023, Case #: 22-40728, Categories: fraud, health Care, Negligence
J. Ecker finds the trial court properly ruled in favor of the home health care company on claims of tortious interference with a contract against its competitor. Statements made by the competitor's executive during litigation against a state agency regarding implementation of a new billing system were verifiably false and allowed the competitor to poach more than 80 clients when the home health care company's contract was terminated by the agency. Repeated statements from an executive that his company did not plan to implement the new billing system and would not poach clients also allowed the home health care company to prove damages in excess of $118,000 based on lost clients. Affirmed.
Court: Connecticut Supreme Court, Judge: Ecker, Filed On: October 6, 2023, Case #: SC20642, Categories: fraud, health Care, Interference With Contract
J. Harpool denies the pharmaceutical defendants' motion to dismiss the hospitals' action seeking damages for the cost of treating patients who abuse opioids, alleging the defendants marketed and promoted the opioid drugs in a way that created an epidemic of drug abuse. The hospitals have adequately alleged that defendants employed deceptive practices in the marketing and sales of opioid drugs, and failed to report large distributions as required by law to prevent harm to local communities.
Court: USDC Western District of Missouri, Judge: Harpool, Filed On: September 28, 2023, Case #: 6:22cv3192, NOS: Personal Injury - Health Care/Pharmaceutical Personal Injury/Product Liability - Torts - Personal Injury, Categories: fraud, health Care, Negligence
J. Wiener finds the district court improperly denied the investigative journalist’s motion to intervene to challenge the sealing of records in the closed False Claims Act matter which alleged that the health provider routinely billed for nonexistent examinations and critical care services. Intervention is permitted by nonparties who seek only to challenge record-related restrictions, and so the journalist has standing. The matter is remanded for reconsideration of timeliness and other unexplored reasons for denial, with the Fifth Circuit still emphasizing the district court’s ultimate discretion. Reversed and remanded.
Court: 5th Circuit, Judge: Wiener, Filed On: August 31, 2023, Case #: 22-40707, Categories: fraud, health Care, Public Record
J. Doughty grants a request by a seaman, dismissing his employer’s lawsuit for a ruling that it owes no living expenses and medical care for injuries sustained while cleaning tanks on a docked drilling rig, based on allegations that he denied any prior back and knee injuries and previous drug use. The dismissal is based on a magistrate judge’s survey of Western District precedents for declaratory rulings in “maintenance and cure” cases. The ruling allows the seaman to pursue his claims against his employer in state court.
Court: USDC Western District of Louisiana , Judge: Doughty, Filed On: August 15, 2023, Case #: 6:22cv5808, NOS: Marine - Contract, Categories: fraud, health Care, Maritime
J. Vance grants summary judgment to a dredging company and against a seaman suing for living expenses and medical treatment after he was allegedly injured when a walkway flipped over on his employer’s vessel. The seaman intentionally concealed or misrepresented medical facts when he stated in his medical history questionnaire that he had never experienced any back pain or injuries, leg injuries, back injuries, herniated discs or recurrent neck or back pain, and that he never had an MRI or other surgery.
Court: USDC Eastern District of Louisiana , Judge: Vance, Filed On: August 14, 2023, Case #: 2:22cv4271, NOS: Marine - Contract, Categories: fraud, health Care, Maritime