Cost-Effective, Proactive Representation



Blog Posts in 2018

  • Prime Healthcare Primed to Pay $65M in FCA Settlement

    Prime Healthcare Services and its CEO recently agreed to pay $65 million to settle a whistleblower suit alleging that 14 Prime hospitals in California violated the False Claims Act (FCA) by “upcoding” the care of Medicare patients. See Press Release, U.S. Dep’t of Justice, Prime Healthcare Services and CEO to Pay $65 Million to Settle False Claims Act Allegations (Aug. 3, 2018), ...
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  • Second Circuit Holds Insurance Companies Had Duty to Defend in Wrongful Death Lawsuit

    Second circuit reverses decision in coverage dispute over construction site fatality A lawsuit from 2014 alleges that Hellman Electric Corporation, the Metropolitan Transportation Authority, and the Triborough Bridge and Tunnel Authority negligently caused the death of Nicholas Cavataio when a 2,700-pound battery struck him at a construction site. Cavataio was an employee of Hellman at the time of ...
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  • Don't Mess with Texas Medicaid

    Texas Reaches $15.2M Settlement with Fraudulent Medicaid Providers Texas Attorney General Ken Paxton announced on May 30, 2018 that the state of Texas reached settlements totaling $15.2 million with a group of Dallas-Fort Worth area Medicaid rehabilitation therapy providers that were accused of making false statements and conspiring to avoid repaying unauthorized Medicaid benefits. Background ...
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  • 4th Circuit Voids "Other Insurance" Clause in Yacht Crash Coverage Dispute

    Beware of state statutory language that can shift liability In a recent decision, Nat’l Liab. & Fire Ins. Co. v. State Farm Fire & Cas. Ins. Co. , No. 17-1969 (4th Cir. May 31, 2018), the 4th Circuit Court of Appeals ruled that an insurance company could not use an “other insurance” clause in its personal injury policy to shift all liability stemming from a yacht accident to a fellow insurer. ...
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  • HHS $2B Healthcare Fraud Takedown

    The Department of Justice is taking on “the most defendants ever charged in health care fraud” as the nationwide opioid crisis continues. Almost 200 doctors and 220 other medical professionals have been charged with opioid-related crimes since January 2017. According to Attorney General, Jeff Sessions, “this is the most doctors and the most medical personnel, and the most fraud that the Department ...
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  • Ace in the Hole: Insurer Escapes $105.7M Judgment

    Last year, in Great Am. Ins. Co. v. Hamel , 525 S.W.3d 655 (Tex. 2017), the Texas Supreme Court decided that a judgment rendered against an insurance company’s policyholder in an underlying action was unenforceable against the insurance company because the judgment was not the product of a fully adversarial proceeding. In what may be the first federal use of the Hamel decision, a Texas federal ...
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  • SC Supreme Court Supports Insurer's Direct Suit for Attorney Malpractice

    South Carolina joins 24 other states in monumental ruling A divided South Carolina Supreme Court recently ruled that an insurance company may directly pursue a legal malpractice claim against counsel retained to defend its policyholder. The decision in Sentry Select Insurance Co. v. Maybank Law Firm LLC et al. , No. 27806 (S.C. May 30, 2018), changes roughly 200 years of South Carolina common law ...
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  • Washington Supreme Court Sides with Insureds on PIP Coverage

    In a decision earlier this month, the Washington Supreme Court held that state regulation prohibits insurers from denying a policyholder’s personal injury protection (PIP) coverage even if it is not necessary to achieve maximum medical improvement (MMI). Durant v. State Farm Mutual Auto Ins. , No. 94771-6, 2018 WL 2727997 (Wash. June 7, 2018). Background A State Farm policyholder was denied PIP ...
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  • Affidavits from Subrogation Agents on Medical Expenses allowed in Texas

    Insurance carriers come into play when determining reasonableness In a recent decision by the Texas Supreme Court, Gunn v. McCoy , the Court allowed plaintiffs to file affidavits from subrogation agents for health insurance providers to prove reasonableness of medical expenses pursuant to Texas Civil Practices and Remedies Code § 18.001. On appeal, the defendant contended that the plaintiff’s ...
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  • False Claims Act and the Materiality Standard

    Supreme Court Seeks Solicitor General’s Views on Certiorari for FCA Materiality Standard FCA History It comes as a surprise to many that the False Claims Act (FCA), 31 U.S.C. §§ 3729 – 3733, stretches back to the Civil War. Originally enacted in 1863 to combat fraud against the Union Army by suppliers, the FCA was not changed significantly until 1986, at which point double damages were increased ...
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  • Dallas Attorney Defrauds Federal Government of Approximately $26 Million

    Workers’ Compensation Scheme targets the Department of Labor Tshombe Anderson, a Dallas-area attorney, was sentenced to 10 years in federal prison and ordered to pay approximately $26 million as restitution for a fraud scheme he ran. Anderson, along with his wife, sister, and niece, filed false claims for medical equipment with the Department of Labor’s Office of Workers’ Compensation Program. The ...
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  • The Liability of Self-Driving Vehicles

    On March 18, 2018, an Uber autonomous vehicle struck and killed a woman crossing a dark street in Tempe, Arizona. In early May 2018, a self-driving minivan of Waymo was involved in a crash in Chandler, Arizona. The first known fatality from an autonomous vehicle came in 2016 when one of Tesla’s autonomous vehicles failed to sense a tractor-trailer crossing the highway near Williston, Florida. In ...
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  • Physician In McAllen, Texas Convicted of Healthcare Fraud After Eighteen Years

    For 18 years, Jorge Zamora-Quezada, a physician based in McAllen, Texas, enjoyed a lavish lifestyle—flying in private jets, driving luxury vehicles, and purchasing high-end clothing—at the mercy of his patients who underwent numerous medical treatments upon false diagnosis. Zamora-Quezada and his co-conspirators traveled between the Rio Grande Valley and San Antonio conducting unwarranted ...
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  • Civil Procedure Rules Strike Again

    Insured Sees Claim Dismissed for Improper Joinder For many attorneys, the rules of civil procedure are like a minefield. There are hidden traps everywhere as they seek to move their case along. One wrong step and BOOM, your case could be dismissed. That is exactly what happened in a recent case out of Dallas in Caruth v. Chubb Lloyd’s Insurance Company of Texas , No. 3:17-CV-2748-G. (Full case ...
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  • Anti-SLAPP Statute Combats Conspiracy Claim

    SLAPPs (Strategic Lawsuits Against Public Participation) are often filed with the primary intent to censor, intimidate, or silence a defendant. By burdening the defendant with the costs of litigation, SLAPP suits seek to dissuade a defendant from exercising his or her First Amendment rights. To guard against the chilling effect of SLAPPs, 28 states, the District of Columbia, and Guam have enacted ...
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