Insurance Fraud

Rule 9(b) Pleading Requirements Under the False Claims Act
May 5, 2022 | Michael A. Sirignano | Insurance Fraud

The Justice Department recently reported obtaining more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2021. This is the largest annual total in False Claims Act (FCA) history since 2014, no doubt spurred in part by fraud related to COVID-19. This

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The Opioid Crisis: An Epidemic Exacerbated by Fraud
March 4, 2022 | Michael A. Sirignano | Insurance Fraud

The terrible, terrible losses associated with the opioid epidemic are almost too horrifying to describe. Statistics alone cannot explain its scope, but it is important to note that, last year alone, over 100,000 Americans died from drug overdoses across the country. Strikingly, the increase in overdose numbers during the COVID-19 pandemic took place in all

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An Insurance Fraud Year in Review
January 6, 2022 | Michael A. Sirignano | Insurance Fraud

The year 2021 will be remembered for many things, of course including that, as of this writing, a total of more than 800,000 Americans have died from COVID-19 since the beginning of the pandemic. For lawyers who represent insurance companies in cases seeking to challenge fraudulent claims and other types of insurance fraud, as well

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COVID-19 and the Explosive Rise of Unemployment Insurance Fraud
November 4, 2021 | Evan H. Krinick | Michael A. Sirignano | Insurance Fraud

In mid-May, U.S. Attorney General Merrick Garland established the COVID-19 Fraud Enforcement Task Force. Attorney General Garland directed the task force to use the resources of the U.S. Department of Justice in partnership with agencies across government to enhance enforcement efforts against fraud related to the COVID-19 pandemic. Even by that time – more than

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Confluence of Corrupt Interests Can Lead to Massive No-Fault Frauds
September 3, 2021 | Evan H. Krinick | Michael A. Sirignano | Insurance Fraud

In March 2020, as the COVID-19 pandemic was first beginning to take hold, the New York State Department of Financial Services (DFS) issued a report on insurance fraud that highlighted the fact that suspected no-fault automobile insurance fraud accounted for 59 percent of the 25,985 insurance fraud reports that the DFS’s Insurance Frauds Bureau received

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Compounding the Fraud: Questionable Billing by Pharmacies
July 6, 2021 | Evan H. Krinick | Michael A. Sirignano | Insurance Fraud

As the COVID-19 pandemic was taking hold last April, the Manhattan U.S. Attorney filed a lawsuit against FPR Specialty Pharmacy LLC and Mead Square Pharmacy, Inc., and their owners, Christopher Casey and William Rue, alleging that they had submitted fraudulent claims for reimbursement to federal healthcare programs for compounded prescription drugs in violation of the

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False Claims Act Cases Poised to Jump Now and for Years to Come
March 4, 2021 | Evan H. Krinick | Insurance Fraud

The report detailing new filings and recoveries under the False Claims Act (FCA) during the 2020 fiscal year that was just released by the U.S. Department of Justice (DOJ) suggests, at first glance, a diminished role for one of the federal government’s strongest anti-fraud tools. Delving more deeply into the details, however, demonstrates the continuing

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Municipal Fraud in Focus as Local Governments Face Budget Woes
December 31, 2020 | Insurance Fraud

Nearly a decade ago, in October 2011, Preet Bharara, then serving as U.S. Attorney for the Southern District of New York, announced pension disability fraud charges against a number of individuals associated with the Long Island Railroad (LIRR). The complaint estimated a potential loss to the Railroad Retirement Board of more than $1 billion in

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No-Fault Insurers May Obtain Non-Party Discovery in Fraud Cases
November 6, 2020 | Insurance Fraud

Fifteen years ago, the New York Court of Appeals ruled that a violation of a licensing requirement by a medical provider rendered the provider ineligible to be reimbursed by an insurance company for no-fault claims that had been assigned to the provider by an individual allegedly involved in an automobile accident. The court recognized that one

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NY Law Remains Unclear on Non-Party 5th Amendment Invocations and Negative Inferences
September 14, 2020 | Insurance Fraud

The Fifth Amendment “not only protects the individual against being involuntarily called as a witness against himself in a criminal prosecution but also privileges him not to answer official questions put to him in any other proceeding, civil or criminal, formal or informal, where the answers might incriminate him in future criminal proceedings.” Lefkowitz v. Turley,

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