Insurance Fraud


As Telemedicine Expands, Insurance Fraud Grows
September 1, 2022 | Michael A. Sirignano | Health Services | Insurance Fraud

With the strong support of regulators, including in New York, telemedicine has significantly expanded since the beginning of the COVID-19 pandemic. See, e.g., New York State Department of Health, Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services, available at https://www.health.ny.gov/health_care/medicaid/program/update/2021/no07_2021-06_covid-19_telehealth.htm; Governor Hochul Announces $3 Million in New Grants to Expand Access to Telehealth across

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Private Insurers Must Watch Out for Medical Equipment Fraud
August 10, 2022 | Michael Vanunu | Compliance, Investigations & White Collar | Insurance Fraud

Healthcare fraud related to durable medical equipment (DME) is extremely costly to insurers yet often continues without criminal or civil consequences.

Fraudulent schemes by DME supply companies vary in complexity but usually prove extremely costly to insurers. Likely victims of DME fraud include Medicaid, Medicare, automobile insurers, workers’ compensation insurers, and other private health insurers.

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The Anti-Kickback Statute’s Role in Health Insurance Fraud Cases
June 30, 2022 | Insurance Fraud

Alleged violations of the federal Anti-Kickback Statute (AKS) are more and more often at the heart of actions involving accusations of health insurance fraud brought under the False Claims Act (FCA). Consider, for example, the amended complaint that was just filed by the U.S. Justice Department to add six physicians as defendants to the original

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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. https://www.justice.gov/opa/pr/justice-department-s-false-claims-act-settlements-and-judgments-exceed-56-billion-fiscal-year. 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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