AHA was referring to a report from Department of Health and Human Services’ (HHS’) Office of Inspector General (OIG) last month. OIG looked at a random sample of 250 prior authorization denials made by 15 major insurers back in 2019. It found that only 13% of the denials followed Medicare coverage requirements and so did only 18% … Read more
See the complete article here: https://generalcounselnews.com/%e2%80%8bwhistleblower-usaa-actively-lying-to-regulators/ Download PDF of article click here
Steven Monaco, 40, was accused of leading two related scams that defrauded public health insurance plans, according to the U.S. Attorney’s Office for New Jersey. In one scheme, the Sewell man arranged for kickbacks with a doctor, Daniel Oswari, that allowed Monaco to receive $36,000 in commissions as a sales representative for a medical diagnostic laboratory between late … Read more
NEWARK, N.J. — Sagy Grinberg, 39, of Weehawken, N.J., was arrested on Friday, April 1 and charged with the following: Health care claims fraud (2nd degree); Forgery (two counts, 3rd degree); Obtaining Xanax by fraud (3rd degree); Obtaining Oxycodone/Percocet by fraud (3rd degree); Obtaining D-Amphetamine by fraud (3rd degree); Obtaining Adderall by fraud (3rd degree); and … Read more
NEWARK, N.J. — A doctor convicted of health care fraud and conspiracy to commit health care fraud in connection with her filing of fraudulent claims to Medicare and private insurance companies is not entitled to a new trial based on testimony submitted by government prosecutors at trial because the conduct alleged in the testimony was … Read more
Congratulations to our colleague Gabrielle Pohlman for obtaining a $1.6 million summary judgment against the sham owner of an acupuncture clinic. Gabrielle then successfully defended the judgment on appeal. There is nothing we like more than putting money back in the pockets of our clients. https://www.njcourts.gov/attorneys/assets/opinions/appellate/unpublished/a5340-17.pdf?c=Db4
A Jersey City pharmacy and its owner have paid $62,500 to settle allegations that they violated the New Jersey False Claims Act by submitting false Medicaid claims, in a case litigated by Kennedy Vuernick. The civil settlement agreement resolves allegations that UMR Pharmacy and Surgical, Inc., (“UMR”) and its owner Mohammad Ziauddin (“Ziauddin”), submitted false … Read more
Appellate Division upholds $1.6 million insurance fraud judgment won by Kennedy Vuernick The Appellate Division has upheld a judgment of approximately $1.6 million that Kennedy Vuernick obtained against the operator of an acupuncture clinic. Kennedy Vuernick represented Allstate Insurance Company, which sued under the Insurance Fraud Prevention Act. The suit alleged that the acupuncture clinic … Read more
John Kennedy is quoted in Law360 article covering Kennedy Vuernick’s successful False Claims Act settlement The Appellate Division has upheld a $718,000 settlement obtained by Kennedy Vuernick against the owner of ambulatory care facilities over charges that he bilked the state’s charity care fund. Kennedy Vuernick represented the two whistleblowers, Allstate Insurance Company and Medical … Read more
CAMDEN, N.J. — In a one-page order, a federal judge in New Jersey on Dec. 20 issued a judgment in favor of an insurer in a homeowners insurance dispute stemming from the insurer’s denial of its insureds’ claim for fire losses based on alleged material misrepresentations the insureds made in their claim.