Insurance Fraud


‘Public Disclosure’ Bar Can Limit False Claims Act’s Fraud Suits
November 1, 2023 | Michael A. Sirignano | Insurance Fraud

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.

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Fraudulent Incorporation Confirmed as Basis for Criminal Healthcare Fraud Charges
August 31, 2023 | Michael A. Sirignano | Insurance Fraud

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

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Fraudulent Injury Lawsuits/Unnecessary Surgeries Exposed in Trip-and-Fall Scheme
July 6, 2023 | Michael A. Sirignano | Insurance Fraud

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

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Recissions Based on ‘Material Misrepresentations’ Can Help Combat Fraud
May 4, 2023 | Michael A. Sirignano | Insurance Fraud

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

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Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!
March 2, 2023 | Michael A. Sirignano | Insurance Fraud

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

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An Insurance Fraud Year in Review
January 5, 2023 | Michael A. Sirignano | Insurance Fraud

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

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The Triple Threat of Workers’ Compensation Fraud
November 3, 2022 | Michael A. Sirignano | Insurance Fraud

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

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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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