Last week Government Employees Insurance Co., known as GEICO, filed a massive lawsuit against Path Medical and Pain 411, alleging that since 2014 the defendants defrauded the company for millions of dollars worth of medical procedures that were, “medically unnecessary, illusory, unlawful, and otherwise unreimbursable health care services, including initial examinations, follow-up examinations, diagnostic imaging, and physical therapy, and chiropractic services , that purportedly were provided to automobile accident victims (“Insureds”) who were eligible for coverage under GEICO Florida no-fault insurance policies.”
In addition to seeking compensatory damages for the allegedly fraudulent payments, GEICO is also seeking declaratory judgment that it is not legally obligated to reimburse the more than $200,000 in additional pending, allegedly fraudulent no-fault insurance claims.
GEICO alleges that the defendants began their fraudulent practices sometime during 2014, and that the practices have continued uninterrupted since that time.
The case was filed in the United States District Court for the middle division of Florida because the GEICO complaint alleges that the defendants are Florida residents.
The lawsuit alleges that the defendants used their companies to refer cases in violation of the Patient Brokering Act, Anti-Kickback Statute, Self-Referral Act, Clinic Act, and Chiropractor Advertising Laws.
The case is relevant to personal injury law as the insurance payments were made pursuant to the Personal Injury Protection, which allows for the driver of a vehicle to benefit from $10,000 in medical benefits paid by their own insurance company regardless of fault. This allows for victims of auto accidents to pursue care without having to first pursue legal action.
The Florida Personal Injury Protection (PIP) law allows for an injured person to assign their benefits to a selected health care provider, thus allowing the professional to bill directly to the car insurance company in order to receive payment.
The suit lays out extensive information relating to the past history of the companies and individuals running them. The claims include the use of alleged puppet medical directors/doctors to oversee the filing of medical claims, which allegedly ran in the tens of thousands as billed to GEICO alone.
Allegations of false legal advertising have also been reported by other sources, alleging that 411 pain stated that individuals could receive $10,000 just by contacting the company, when the ad was actually referring to the PIP benefits.
Aside from the monetary damages GEICO is alleging, what is unfortunate about the allegations made in the complaint is that they have the potential to harm Floridians. Whenever a massive string of fraud occurs, especially as it relates to medical benefits and reimbursements, it is undoubtedly likely to result in the legislature or at least car insurance companies looking into whether they should make it more difficult for people to obtain payment for medical services. It is unfortunate because when you become injured in a car accident, you may not have enough cash on hand to cover any out of pocket costs that may come up. That’s why the ease of accessing the PIP benefits is such a blessing to those Floridians that need it.
If you or a loved one has been involved in a car accident, whether a routine car accident or catastrophic injury claim our Miami, Florida personal injury law firm is here to help. If you or a loved one have been seriously injured in a car accident don’t wait. Contact a car accident attorney at Gerson & Schwartz, PA today.
Insurance Policy Exclusions May Interfere With A Personal Injury Claim and Why You should Read the Language in Your Insurance Policy. Miami Injury Lawyer Blog, published February 20, 2015
Medicare Fraud Indictment Proves Elders Are Abused In Nursing Homes, Miami Injury Lawyer Blog, published November 28, 2017