Insurance Fraud

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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Second Circuit Cases May Affect Insurers’ Ability To Fight No-Fault Fraud
March 6, 2020 | Insurance Fraud
A case that has been appealed to the U.S. Court of Appeals for the Second Circuit, and one that has just been argued in that court, have the potential to significantly affect the ability of insurance companies to fight no-fault insurance fraud in New York. The defendants in Government Employees Ins. Co. v. Wellmart RX, …
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A Tale of Two States: Fighting No-Fault Insurance Fraud Under Unfair Business Practices Laws
September 6, 2019 | Evan H. Krinick | Insurance Fraud
Insurance fraud is not only a New York problem, or even solely a northeast concern. Insurance fraud is prevalent across the country. In particular, no-fault insurance fraud can be found in every state with a significant no-fault insurance program. State legislatures have adopted a wide variety of statutes in an effort to protect consumers and …
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Kam Authors Article for ABA
May 11, 2018 | Priscilla D. Kam | Insurance Fraud
Priscilla Kam has authored an article entitled, “How to Keep the Focus and Stay Motivated On the Long Road to Success,” for the American Bar Association’s Tort Trial and Insurance Practice – Young Lawyer’s Division newsletter. Click here to read the article. © 2018 by the American Bar Association. Reproduced with permission. All rights reserved. …
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Employee Benefit Plan Review – From the Courts
March 2, 2018 | Employment & Labor | Insurance Fraud
Fifth Circuit Holds ERISA Preempts Plaintiff’s Claims under State Law, and Plaintiff’s Claim for Equitable Relief Fails as a Matter of Law The plaintiff in this case sought to recover life insurance benefits under  an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Her deceased husband had been …
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