No Coverage for Fraudulent Withdrawal of Electronic Funds

In Metro Brokers, Inc. v. Transp. Ins. Co., 2015 U.S. App. LEXIS 3473 (11th Cir. Ga. Mar. 5, 2015) an all risk policy was held to not provide coverage to an insured real estate brokerage company for online fraudulent withdrawals from the company’s bank account.

On December 10, 2011, thieves logged into the insured’s online banking system and authorized payments totaling over $188,000 from the insured’s escrow account to several other bank accounts. They had used a virus known as “Zeus” to gain access to …

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Health Care Providers Ordered to Pay Insurer $8.4M for Billing Fraud

Three health care providers were forced to pay a judgment for defrauding an insurance company of millions of dollars. A Texas Federal Judge found that the defendant health care providers were wrongfully posing as emergency rooms in order to bill the insurance company at higher rates, in violation of Texas law.

The judge stated that a hospital sold the right to use its license-derived billing codes to various clinics in exchange for 15 percent of each of the clinics’ bills. The clinics then used these …

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