Allstate Insurance Company v. Community Medical Imaging, P.C.

CourtDistrict Court, E.D. New York
DecidedAugust 28, 2024
Docket1:24-cv-01832
StatusUnknown

This text of Allstate Insurance Company v. Community Medical Imaging, P.C. (Allstate Insurance Company v. Community Medical Imaging, P.C.) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Insurance Company v. Community Medical Imaging, P.C., (E.D.N.Y. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ALLSTATE INSURANCE COMPANY, ALLSTATE RAN INDEMNITY COMPANY, ALLSTATE FIRE & oa cy. 018 3 IN coy cae CASUALTY INSURANCE COMPANY, and ( ) (LEE) ALLSTATE PROPERTY & CASUALTY INSURANCE COMPANY, Plaintiffs, -against- COMMUNITY MEDICAL IMAGING, P.C., COMMUNITY MEDICAL IMAGING OF BROOKLYN, P.C., ANDREW J. MCDONNELL, M.D., GRIGORIY VAYNSHTEYN, a/k/a GREGORY VAYNSHTEYN, and GLOBAL STONE ASSOCIATES, ING., Defendants.

NICHOLAS G. GARAUFIS, United States District Judge. Plaintiffs Allstate Insurance Company, Allstate Indemnity Com- pany, Allstate Property and Casualty Insurance Company, and Allstate Fire and Casualty Insurance Gompany (collectively, “All- state” or “Plaintiffs”) bring this action against Community Medical Imaging, P.C. (“CMI”), Community Medical Imaging of Brooklyn, P.C. (““CMIBK”) (collectively, “PC Defendants”), An- drew J. McDonnell, M.D. (“McDonnell”), Grigoriy Vaynshteyn a/k/a Gregory Vaynshteyn (“Vaynshteyn”), and Global Stone As- sociates, Inc. (“Global Stone”) (collectively, “Defendants”), alleging that Defendants defrauded Allstate in violation of the Racketeering Influenced and Corrupt Organizations Act (“RICO,” 18 U.S.C, § 1962(c), (d)), by submitting hundreds of fraudulent bills for no-fault insurance payments. (See Compl. (Dkt. 1)

419-500.) Plaintiffs also allege common law fraud and unjust en- tichment and seek a declaratory judgment as to all past, present, or future bills. Ud. 4] 501-44.) Before the court is Allstate’s motion for a preliminary injunction to stay all 99 pending no-fault insurance collection arbitrations that PC Defendants commenced against Allstate. (See Not. of Mot. (Dkt. 24-1); Mot. to Stay (Dkt. 24-2) at 1 & n.1.) Addition- ally, Plaintiffs request that this court waive their obligation to post security for the injunction. (See id. at 23-24.) For the reasons set forth below, Plaintiffs’ motion for injunctive relief is GRANTED and their request for oral argument is DENIED as moot. Allstate’s request that the court waive their obligation to post security is also GRANTED. I. BACKGROUND! A. New York’s No-Fault Insurance Scheme Under New York’s Comprehensive Motor Vehicle Insurance Rep- arations Act (N.Y. Ins. Law § 5101, et seq.), and the regulations promulgated pursuant thereto (N.Y. Comp. Codes R. & Regs. (“N.Y.C.R.R.”) tit. 11 § 65, et seq.) (collectively, “the No-Fault Laws”), an automobile insurer is required to provide certain no- fault insurance benefits (“Personal Injury Protection” or “No- Fault benefits”) to the individuals that they insure (“Insureds”). No-Fault benefits cover up to $50,000 per eligible person for rea- sonable expenses incurred for necessary medical services resulting from automobile accidents. See N.Y. Ins. Law § 5102(a)(1); 11 N.Y.C.R.R. § 65-1.1. This legislative scheme is de- signed to “ensure prompt compensation for losses incurred by accident victims without regard to fault or negligence, to reduce the burden on the courts and to provide substantial premium sav- ings to New York motorists.” State Farm Mut. Auto. Ins. Co. v. 1 The following background is taken from the allegations of the Complaint and declarations submitted by Allstate in connection with this motion.

Herschel Kotkes, M.D., P.C., No. 22-CV-03611 (NRM) (RER), 2023 WL 4532460, at *1 (E.D.NLY. July 13, 2023)).? Insureds may assign their No-Fault benefits to healthcare provid- ers in exchange for services, and in turn, the provider, rather than the Insured, files no-fault claims with the insurance company di- rectly. (Compl. {"{ 96-97.) See also 11 N.Y.C.R.R. § 65-3.11{a) (providing that the benefits may be paid only “directly to the ap- plicant” or “upon assignment by the applicant .. . directly to providers of health care services”). Providers are prohibited from receiving No-Fault benefits, however, if they “fail[] to meet any applicable New York State or local licensing requirement neces- sary to perform such healthcare services.” 11 N.Y.C.R.R. § 65- 3.16(a)(12); see also State Farm Mut. Ins. Co. v. Mallela, 4N.Y.3d 313, 320-21 (N.Y. 2005). This includes, inter alia, that unli- censed professionals, ie., non-physicians, may not own or control a medical professional corporation, serve as a director or officer of said corporation, enter into any agreements with the corpora- tion’s shareholders, or receive shares or otherwise derive economic benefit from the corporation’s professional services. (Compl. | 86-92); see N.Y. Bus. Corp. Law §8 1507, 1508; New York Education Law § 6530(19); see also Allstate Ins. Co. v. Lyons, 843 F. Supp. 2d 358, 371 (E.D.N.Y. 2012). Licensed healthcare services providers, including physicians, are also prohibited from engaging in fraudulent activity, including ordering excessive tests or treatment not warranted by the condition of the patient, making material misrepresentations regarding a provider’s eligi- bility to seek or collect payment under New York’s No-Fault laws, and/or accepting kickbacks in exchange for patient referrals. (Compl. {{ 94-109); see, e.g., N.Y. Bus. Corp. Law §§ 1503, 1507; New York Education Law § 6530; N.Y. Ins. Law § 5102(a).

2 When quoting cases, and unless otherwise noted, all citations and quota- tion marks are omitted, and all alterations are adopted.

Moreover, insurers are only given 30 days to review and investi- gate claims before paying those claims to avoid risk of penalty for denying or delaying a claim. See 11 N.Y.C.R.R. § 65-3.8(a); see also Med. Soc’y of State v. Serio, 100 N.Y.2d 854, 861 (N.Y. 2003). After 30 days, interest begins to accrue at a rate of two percent per month, See N.Y, Ins. Law § 5106(a). Claimants may dispute unpaid no-fault claims either in a state civil action or in an arbi- tration proceeding. See 11 N.Y.C.R.R. § 65-4.1, et seq.; N.Y. Ins. Law § 5106(a). In No-Fault collection actions, including arbitra- tions before the American Arbitration Association (“AAA”), the proceedings are conducted through “an expedited, simplified af- fair meant to work as quickly and efficiently as possible.” Allstate Ins. Co. v. Mun, 751 F.3d 94, 99 (2d Cir. 2014). And these pro- ceedings typically have “limited opportunities for pre-hearing discovery or examinations of witnesses during the hearing,” which “can produce differing—and often inconsistent—tesults.” (Michael Flaherty Declaration (“Flaherty Decl.”) (Dkt. 24-3) "4 7-8.) Moreover, New York’s No-Fault laws impose mandatory, non-refundable fees upon insurers to help fund the costs of the no-fault arbitration system. Ud. 1 19); see 11 N.Y.C.R.R. § 65- 4,2(c)(1). These fees are apportioned to insurers based on the number of collection arbitrations filed against them, meaning that costs to the insurers increase with each new arbitration filed regardless of whether the insurer prevails in the action. (Flaherty Decl. § 19); see 11 N.Y.C.R.R, § 65-4.2(c)(1). B. Operation of the Alleged Scheme According to Allstate, the Defendants’ fraudulent scheme began with Grigoriy Vaynshteyn, an unlicensed person who has been implicated in prior No-Fault schemes. (Compl. {4 38-40, 117 (cit- ing no-fault cases).) Defendant Vaynshteyn initially managed and controlled Professional Health Radiology, P.c. (“PHR”), CM?’s predecessor. (Id.

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Allstate Insurance Company v. Community Medical Imaging, P.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-company-v-community-medical-imaging-pc-nyed-2024.