Health Care and Insurance Fraud

Morrison Mahoney provides comprehensive legal, advisory, consultative and litigation services to industries and organizations subject to attack or otherwise victimized by organized schemes to defraud. Morrison Mahoney’s commercial fraud and forensic detection, prevention and affirmative recovery practice group is comprised of highly skilled and experienced litigators, including former prosecutors and industry recognized attorneys, with a proven track record of developing fraud prevention plans, identifying patterns of fraud through the utilization of forensic tools, civilly prosecuting fraud rings and, where appropriate, referring matters to federal, state and/or local law enforcement agencies for investigation and criminal prosecution.

Morrison Mahoney’s team of attorneys has litigated commercial and healthcare fraud actions in New York and throughout the United States. In additional they have provided advisory opinions concerning emerging schemes to defraud commercial organizations and guidance regarding the best course of action to minimize exposure to fraud.

Health Care and Insurance Fraud

With respect to insurance fraud, Morrison Mahoney has represented insurers that have been defrauded by medical mills billing for services never rendered or not provided as billed, illegal corporate structures, fraudulently incorporated, formed and operated in violation of applicable laws and regulations, as well as those engaged in illegal self-referrals and kickback arrangements.  The firm also has provided advisory services to help its insurance defense clients develop and implement tools to detect and prevent fraud. In addition, the firm has provided training to senior management, special investigative units and claims’ departments to increase awareness of emerging industry trends and changes in the law.

Apart from other commercial industries, the firm provides sophisticated services relating to No-fault laws, workers’ compensation systems and health insurance plans. In addition to assisting our clients in identifying and investigating medical mills, the firm provides advisory opinions concerning emerging schemes to defraud in the health-law reimbursement sectors and what can be done to minimize exposure and, where appropriate, file affirmative recovery actions to recoup fraudulent payments made to health care providers.

Services Provided to New York State No-Fault Insurers

Morrison Mahoney’s team of attorneys has offered the following representative services:

• conducting first-party and third-party examinations under oath;
• conducting forensic investigations relating to complex schemes to defraud;
• drafting and preparing training manuals and fraud prevention to comply with applicable law, such as section 409 of the New York State Insurance Law;
• facilitating criminal prosecution of fraudulent claimants by acting as a liaison between its clients and law enforcement agencies;
• drafting and submitting reports with the appropriate agencies, such as the New York State Insurance Frauds Bureau for prosecution;
• commencing civil law suits to recover compensatory, punitive and, in some cases, treble damages, based on common law fraud, RICO and other claims sounding in tort and contract;
• prosecuting health insurance fraud, medical mills and organized rings, staged theft losses, auto theft and arson;
• defending first-party and third-party bad faith litigation and coverage litigation issues;
• working with special investigators to achieve favorable dispositions;
• pursuing restitution for payments based on fraudulent claims;
• creating reviewing and improving anti-fraud systems;
• advising clients on compliance with federal, state and local reporting requirements concerning fraudulent claims;
• tailoring anti-fraud systems to minimize exposure to civil liability;
• apprising clients of new trends, specific to the relevant industry, and
• providing summaries of recent federal, state and local legislative enactments