Artificial intelligence (AI) is affecting many industries, and it will have a growing effect on lawyers. Insurers’ lawyers may be among the first affected. AI provides efficiencies. These efficiencies are important to insurers. Lawyers will be pushed to use AI.

No health insurance benefit program, no matter how high profile, is immune to the temptations of insurance fraud. In the past, multiple former NFL players pleaded guilty to defrauding the NFL Player Health Reimbursement Account Plan. According to the Justice Department, the defendants submitted about $2.9 million in false and fraudulent claims for expensive medical

On Jan. 16, 2024, in the U.S. District Court for the Southern District of New York, the final two defendants in United States v. Pierre, Dkt. No. 1:22-cr-00019 (S.D.N.Y.), Arthur Bogoraz and William Weiner, D.O., pled guilty to charges stemming from their involvement in a massive insurance fraud scheme, where the government alleged that the defendants

The federal False Claims Act (FCA) imposes civil liability on anyone who “knowingly presents” a “fraudulent claim for payment” to the federal government. 31 U.S.C. § 3729(a)(1)(A). The FCA’s qui tam provisions allow private citizens, referred to as “relators,” to bring fraud claims on the government’s behalf against those who have violated the FCA’s prohibitions.

The U.S. District Court for the Southern District of New York has denied defense motions to dismiss federal healthcare fraud conspiracy charges predicated on allegations that the defendants falsely represented to no-fault automobile insurance carriers that five medical professional corporations were owned, operated, and controlled by physicians in accordance with New York law.

The decision

Personal injury attorney George Constantine and orthopedic surgeon Andrew Dowd were convicted by a Manhattan federal jury late last year for knowingly profiting from a massive $31 million trip-and-fall accident scheme. Constantine reportedly filed nearly 250 fraudulent personal injury lawsuits, and Dowd performed hundreds of unnecessary knee and shoulder surgeries on patients referred to him

A number of years ago, a couple purchased a three-story house in Woodside, Queens, that contained three separate dwelling units, each with its own kitchen, bathroom, and separate entrance. Thereafter, the couple applied for and obtained a fire insurance policy from Otsego Mutual Fire Insurance Company, indicating on their application that the house was a

The Department of Justice (DOJ) released a report on February 7 detailing the settlements and judgments it obtained under the federal False Claims Act (FCA) for the fiscal year (FY) ending September 30, 2022. The statement provides a wealth of information about the government’s fight against federal program fraud, especially fraud relating to federal health

Lawyers, accountants, other professionals, business people, and consumers who are not directly involved in discovering, challenging, and litigating insurance fraud matters likely would be shocked to learn about the breadth and prevalence of these schemes.

By the same token, one might think that the number and range of insurance fraud-related indictments, convictions, and sentencings in

Workers’ compensation insurance is an important social tool that provides benefits to covered employees who become ill or who get hurt because of their job. The insurance benefits can help cover those employees’ medical expenses and the wages they might lose if they must miss work. Workers’ comp insurance also eases the financial burdens on