Allstate Ins. Co. v. Greenberg

871 A.2d 171, 376 N.J. Super. 623
CourtNew Jersey Superior Court Appellate Division
DecidedDecember 10, 2004
StatusPublished
Cited by2 cases

This text of 871 A.2d 171 (Allstate Ins. Co. v. Greenberg) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Ins. Co. v. Greenberg, 871 A.2d 171, 376 N.J. Super. 623 (N.J. Ct. App. 2004).

Opinion

871 A.2d 171 (2004)
376 N.J. Super. 623

ALLSTATE INSURANCE COMPANY, Allstate Indemnity Company, Allstate New Jersey Insurance Company, Continental Insurance Company and Commercial Insurance of Newark, N.J., Plaintiffs,
v.
Scott GREENBERG, D.C., Access Chiropractic Associates, P.C., Apex Chiropractic Associates, P.C., Chambersberg Chiropractic Associates, P.C., Easton Chiropractic Associates, Inc., Pace Chiropractic Associates, Inc., Middlesex Diagnostic Associates, P.A., Accurate Billing Company, Inc., Neuro Muscular Medical Group, P.A., Roman Sorin, M.D., Brunswick Imaging Corporation, Steven Brownstein, M.D., Donald Cioffi, D.C., Norman Brettler, Defendants.

Superior Court of New Jersey, Law Division, Morris County.

Decided December 10, 2004.

*173 Richard Vuernick and Daniel S. Hunczak, for plaintiffs (Pringle Quinn Anzano, P.C., attorneys).

William D. Levinson, Edison, for defendants Scott Greenberg, D.C., Access Chiropractic Associates, P.C., Apex Chiropractic Associates, P.C., Chambersberg Chiropractic Associates, P.C., Easton Chiropractic Associates, Inc., Pace Chiropractic Associates, Inc., Middlesex Diagnostic Associates, P.A., Accurate Billing Company, Inc. (Eichen Levinson, L.L.P., attorneys).

VILLANUEVA, J.A.D. (retired and temporarily assigned on recall).

In this motion for partial summary judgment, plaintiffs Allstate Insurance Company, Allstate Indemnity Company, Allstate New Jersey Insurance Company, Continental Insurance Company and Commercial Insurance Company of Newark, N.J. ("plaintiffs") seek relief from defendants Scott Greenberg, D.C., Access Chiropractic Associates, P.C., Chambersberg Chiropractic Associates, P.C., Easton Chiropractic Associates, Inc., Pace Chiropractic Associates, Inc., Middlesex Diagnostic Associates, P.A., Accurate Billing Company, Inc. ("the Greenberg defendants") to have defendants disgorge all payments made to them by the plaintiffs and to recover compensatory and treble damages for violating the New Jersey Insurance Fraud Prevention Act (the "Fraud Act"), *174 space N.J.S.A. 17:33A-1 to -30. Plaintiffs contend that defendant Greenberg's ownership of defendant Middlesex Diagnostic Associates, P.A. violated N.J.A.C. 13:35-2.5(b) and constituted an unlawful self-referral in violation of N.J.S.A. 45:9-22.5 and N.J.A.C. 13:44E-2.7; and that Dr. Greenberg, a chiropractor, employed defendant, Roman Sorin, M.D., a plenary licensed physician in violation of N.J.A.C. 13:35-6.16(f)(3)(i).

I.

Dr. Greenberg admitted that he was a doctor of chiropractic licensed to practice in the State of New Jersey, and he incorporated and solely owned all the aforesaid chiropractic facilities. He also admitted that he was the sole owner and shareholder of defendant Middlesex Diagnostic while it was in existence and performed diagnostic testing. Dr. Greenberg has testified that Middlesex Diagnostic did not receive referrals from any medical providers other than the Greenberg chiropractic facilities. Dr. Greenberg has denied that he personally made any referral from his chiropractic facilities to Middlesex Diagnostic.

The plaintiffs' exhibits included documents related to treatment of various patients of Dr. Greenberg's chiropractic facilities and Middlesex Diagnostic which included the referral forms from the specific chiropractic facility to Middlesex Diagnostic and Health Insurance claims forms for the applicable dates of service at both the chiropractic facility and Middlesex Diagnostic.

In the unrebutted certification of Benjamin J. Hickey, an analyst in the Special Investigation Unit of Allstate Insurance Company, he certified "upon further review of Allstate's records, it appears that two separate entities, with separate taxpayer identification numbers ("T.I.N."), submitted bills to Allstate based upon referrals from the Greenberg chiropractic facilities."

He further stated that during the period of July 31, 1996 to February 20, 2000, Allstate received 505 claims for payment from Middlesex Diagnostic with a T.I.N. of XX-XXXXXXX. Of these 505 claimants, the following number of claimants were also seen by a provider employed by one of the Greenberg chiropractic facilities:

Access = 150 claimants; paid amount of $8,107.70
Apex = 120 claimants; paid amount of $6,117,74
Chambersberg = 58 claimants; paid amount of $761
Easton = 133 claimants; paid amount of $7,129.38
Pace = 44 claimants; paid amount of $1,107.55

The amount paid to Middlesex Diagnostic on these 505 claims was $23,223.37.

During the period October 25, 1995 to November 29, 1999, Allstate received 360 claims for payment from Middlesex Diagnostic with a T.I.N. of XX-XXXXXXX. Of these 360 claimants, the following number of claimants were also seen by a provider employed by one of the Greenberg chiropractic facilities:

Access = 81 claimants; paid amount of $18,098.84
Apex = 101 claimants; paid amount of $22,610.04
Chambersberg = 34 claimants; paid amount of $7,795.26
Easton = 54 claimants; paid amount of $14,355.34
Pace = 90 claimants; paid amount of $25,521.26

The amount paid to Middlesex Diagnostic on these 360 claims was $88,380.74.

*175 The total amount Allstate paid to Middlesex Diagnostic based upon a referral from a Greenberg chiropractic facility is $111,604.11, which amount has not been disputed. See R. 4:46-5(a). Greenberg has failed to examine the checks involved even though he apparently has 1099 forms for each payment and has not disputed one payment.

II.

Plaintiffs Allstate contend that Scott Greenberg, D.C., a non-plenary licensed physician, owned a diagnostic facility in violation of N.J.A.C. 13:35-2.5(b) and employed a plenary physician in violation of N.J.A.C. 13:35-6.16. The regulations set forth the criteria required of a "medical screening or medical diagnostic testing facility" which are described in N.J.A.C. 13:35-2.5(b):

Medical screening or medical diagnostic testing (other than clinical laboratory testing), conducted primarily for persons not receiving medical treatment from the testing entity, is nevertheless deemed to be a medical service. Such a practice shall be owned and under the responsibility of one or more physicians each of whom holds a plenary license from the State Board of Medical Examiners. All such testing, irrespective of the stationary or mobile nature of the facility, shall be performed under the authority of a designated responsible physician who shall establish a protocol and a quality assurance program for the specific type of screening or study. Results of all such procedures shall be interpreted by a physician holding a plenary license in this State, and documented in a written report which is preserved by the physician as required by N.J.A.C. 13:35-6.5. (Emphasis added.)[1]

Thus, it is clear the regulations specify that only a plenary licensed physician may own a diagnostic facility, whether it is mobile or stationary. Therefore, any bills Middlesex Diagnostic submitted were in violation of N.J.A.C. 13:35-2.5, and not reimbursable.

Plaintiffs also contend that Greenberg employed a plenary licensed physician, Roman Sorin, M.D., whose license exceeds his own, in violation of N.J.A.C. 13:35-6.16(f)(3)(i), creating an improper employment relationship.

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Cite This Page — Counsel Stack

Bluebook (online)
871 A.2d 171, 376 N.J. Super. 623, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-ins-co-v-greenberg-njsuperctappdiv-2004.