Two Insurance Companies Agree to Pay More Than $2 Million to Resolve False Claims Act Allegations
Two insurance companies that are part of one of the largest providers of automobile insurance in
If an individual has Medicare or Medicaid and other private health insurance coverage, each type of coverage constitutes a "payer." The insurance coverage that pays first, referred to as the "primary payer," typically pays to the limits of its coverage for an individual's health care claims. Generally, if there are health care costs that the primary payer does not cover, these costs may then be paid by the individual's other insurance coverage, referred to as the "secondary payer."
Under federal and
According to the allegations in this case, under "health first" automobile insurance policies that it offered, Progressive designated the policyholder's health insurance carrier as the primary payer for medical claims that arose in connection with an automobile accident. Even though, under the law, Progressive could not decline to make primary payment to Medicare or Medicaid beneficiaries, the company permitted Medicare and Medicaid beneficiaries to elect a "health first" policy. Many of these policyholders in
The allegations were raised in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act. The act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower will receive more than
The settlement is the culmination of an investigation conducted by special agents of the
The government is represented by Assistant
The claims settled by this agreement are allegations only, and there has been no determination of liability. The case is captioned
Defense counsel:
Relator's counsel:
Jeremy Abay Esq. and
Attachment(s):
Download progressive.settlement.pdf (https://www.justice.gov/usao-nj/press-release/file/1010971/download)
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