Insurance & Healthcare Fraud Litigation
- Provider and claimant EUOs
- SIU defense
- Affirmative actions on behalf of insurers
GMR has become the premier law firm in the region specializing in healthcare insurance fraud litigation. With over 35 years of experience, we are recognized for our ability to identify patterns in claims and medical records, along with analyzing data, in order to help our clients resist making payments on fraudulent claims. Regardless of the venue, the GMR team consistently wins trials and helps our clients resist settling non-meritorious claims based on exaggerated or even fraudulent evidence. Not only do we use these tools to defend claims, but we provide consulting services to eliminate the costs caused by fraud and prosecute civil remedies against those who defraud our clients. These affirmative litigation actions may include claims under the federal RICO statute and state insurance fraud statutes, which both allow for the recovery of attorney fees.
Our team is one of the few in the country that has successfully secured trial victories against attorneys, physicians, chiropractors, diagnostic testing centers, pharmacies, and medical facilities engaged in healthcare insurance fraud. These successes include:
- Jury verdict of more than 15 million dollars against a group of physicians, chiropractors, an MRI center, and a pharmacy for fabricating patient records and billing for unnecessary treatment, testing, and pharmaceuticals. The jury verdict not only included insurance benefits paid in PIP claims, but included payments made in third party, personal injury matters. The jury verdict was upheld by a federal appellate court.
- Jury verdict of more than 7 million dollars against a chiropractic office, a chiropractor, and laypersons who owned and controlled the practice and submitted fraudulent bills and records. On the eve of trial, one of the defendants filed for bankruptcy in order to delay the matter. Our team successfully obtained an emergency dismissal of the bankruptcy. The jury’s verdict on damages included all PIP payments as well as payments made in the settlement of third party, personal injury matters.
- Jury verdict of 1.5 million dollars against an attorney and a medical office for submitting fraudulent claims.
Armed with these victories, we achieve meaningful results for our clients by way of substantial settlements often without stepping foot into the courtroom. Additionally, through our forward-thinking consulting services, we help our clients limit their exposure on questionable claims and ensure that they are not damaged by fraudulent practices in the future.
Our insurance and healthcare fraud team assists insurers, and their special investigation units, in defending their policyholders in all forms of actions and proceedings including third party personal injury matters, declaratory judgment actions, and arbitration disputes. We also provide coverage opinions, conduct examinations under oath, and defend carriers in PIP, fire, property, theft, and UM/UIM matters.
Our team, co-chaired by Richard Castagna and Matthew Moroney, is committed to providing the highest quality legal representation in a results-oriented and cost-effective way. We invite you to learn more about our team by reaching out to Rich or Matt.