Archive

December 5, 2022

Optical lens manufacturer Essilor Laboratories of America, Inc. will pay $23.8 million to California to resolve allegations that the company violated the state’s Insurance Frauds Prevention Act when it allegedly provided kickbacks and other unlawful incentives to eye care providers in exchange for these providers’ promises to send business to Essilor. The state’s action was initiated by a whistleblower complaint filed by Christie Rudolph, who will receive a whistleblower reward of approximately $11.1 million. (see earlier settlement) CA

March 14, 2019

The former owner and former COO of Atlanta-based Primera Medical Group, Shailesh Kothari and Timothy McMenamin, were sentenced to prison terms of 6.75 and 7.75 years, respectively, for their roles in submitting more than $8.5 million in fraudulent invoices to private insurance companies for allergy testing and allergy immunotherapy services that were never provided and were not medically necessary.  Defendants submitted bills using the NPIs of doctors who had not performed the tests and, in fact, had no knowledge of the services.  To cover up the fact that the services were not provided, defendants would create false laboratory reports for insurers and patients who requested them.  USAO ND GA

January 4, 2018

Kmart Corporation agreed to a $1 million settlement with the California Department of Insurance to resolve a whistleblower claim brought under the California Insurance Fraud Prevention Act.  KMart contracted with insurance companies to be reimbursed at a rate based on the company's charges to cash-paying customers, but was alleged to have submitted claims to private insurers in amounts that exceeded the agreed-upon rates.  CA

September 5, 2017

Novo Nordisk, Inc. has agreed to $1.1 million to resolve claims that its diabetes drug Victoza was unlawfully promoted for off-label use in violation of the California Insurance Frauds Prevention Act.  The claims were brought in a whistleblower action under that act filed by former Novo Nordisk researcher Peter Dastous, who will receive a share of the settlement.  CA

January 30, 2017

Florida announced a $1.5 million life claim settlement agreement reached with subsidiaries of the Ameriprise Group, RiverSource Life Insurance Company and RiverSource Life Insurance Company of New York. The settlement agreement focuses on the one-sided use of the Social Security Administration’s Death Master File to stop paying a deceased person’s annuity, but not using the same information to find and begin paying the deceased’s family or other beneficiaries for life insurance policies. Florida, California, New Hampshire, North Dakota and Pennsylvania conducted the examination into the companies that led to this agreement. Florida’s allocation of the multi-state settlement payment by Ameriprise is more than $111,000, which covers the costs of the investigations and future compliance monitoring. To date, state insurance regulators have either reached settlements or concluded the investigation of 28 of the top 40 companies constituting 80 percent of the total market. Efforts continue to be focused on the examination of the remaining 12 insurers. FL

November 21, 2016

Pennsylvania announced the filing of criminal charges against 50 individuals following investigations by the Office of Attorney General’s Insurance Fraud Section. The charges are part of a November sweep conducted by the Insurance Fraud Section, which is the largest law enforcement entity in Pennsylvania with specific authority to investigate and prosecute cases of insurance fraud. The total potential fraud involved in these cases is more than $1.1 million. The charges announced involve some of the most common types of insurance fraud. PA

July 18, 2016

Bristol-Myers Squibb agreed to a $30 million settlement to resolve allegations of unlawful kickbacks to physicians in the marketing of Pravachol and other drugs.  The claims were made in a whistleblower suit filed under the California Insurance Frauds Prevention Act by three former Bristol-Myers sales representatives, who will receive a share of the settlement.  CA