Geico v. Moshe, 20-cv-1098 (EDNY 2020)
This probably has to be every medical practice’s worst nightmare. Provide services, send bills to the largest insurance payor, end up with a Rico and find yourself hit with a preliminary injunction. I think what makes it that much worse is that all these cases would settle on average for “85/50” or some variant thereof if the you take 2 I take 1 game is played.
The opinion is short, sweet and to the point
“(1) Yan Moshe (Moshe) has been sued seven times by insurers alleging he previously engaged in similar fraudulent billing activities.
(2) Moshe conspired with individuals, including defendants Leonid Shapiro and Nizar Kifaieh, to run his facilities on paper, while Moshe controlled the facilities without a medical degree. The complaint supports these allegations with specific examples and Kifaieh’s testimony from a prior litigation that he did not pay for ownership of Premier and Moshe provided him with equipment.
(3) Moshe’s facilities, particularly those directed by Shapiro, were repeatedly cited by the New Jersey Department of Health for regulatory violations. In fact, one facility was temporarily closed due to unsanitary conditions.
(4) Defendants unlawfully referred patients to Moshe’s facilities for unnecessary services often without disclosing Moshe’s interest. Defendants subsequently billed GEICO for these unnecessary services.
(5) Defendants prescribed identical treatment for people involved in a single accident despite their varying ages and health conditions. The complaint provides 10 detailed examples of when this occurred.
(6) Regina and Citimedical billed GEICO for services provided in New Jersey even though Citimedical could not lawfully provide services outside New York. The complaint provides 15 detailed examples of when this occurred.
(7) Moshe and Hudson Regional unlawfully requested reimbursement for facility fees that exceeded the limits set by the NJ fee schedule.
(8) Defendants submitted bills purporting that they were in compliance with all laws and regulations while engaging in the above activities.”
What this shows is the power of the Federal Rico statute. There is nothing within the New York State arsenal of common law remedies that comes anywhere close. As a reminder, NY does not have a Civil Rico statute (American Transit’s “DJ’s” appear to believe otherwise).