Allstate Insurance Company v. Pierre

CourtDistrict Court, E.D. New York
DecidedJanuary 8, 2024
Docket1:23-cv-06572
StatusUnknown

This text of Allstate Insurance Company v. Pierre (Allstate Insurance Company v. Pierre) 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. Pierre, (E.D.N.Y. 2024).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ALLSTATE INSURANCE COMPANY, ALLSTATE RAN INDEMNITY COMPANY, ALLSTATE FIRE & vaey 065 70 (NGG) (LB) CASUALTY INSURANCE COMPANY, and ~ ALLSTATE PROPERTY & CASUALTY INSURANCE COMPANY, Plaintiffs, -against- BRADLEY PIERRE, MEDICAL REIMBURSEMENT CONSULTANTS INC., MARVIN MOY, M.D., RUTLAND MEDICAL P.C. d/b/a MEDICALNOW, WILLIAM A. WEINER, D.O., and NEXRAY MEDICAL IMAGING, P.C. d/b/a SOUL RADIOLOGY MEDICAL IMAGING, 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 Company (collectively, “All- state” or “Plaintiffs”) bring this action against Defendants Bradley Pierre, Medical Reimbursement Consultants Inc., Marvin Moy, M.D., Rutland Medical P.c. d/b/a MedicalNow, William A. Weiner, D.O., and Nexray Medical Imaging, P.C. d/b/a Soul Ra- diology Medical Imaging (collectively, “Defendants”)', alleging that Defendants defrauded Allstate in violation of the Racketeer- ing 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) 99 459-542.)

1 Defendants Medical Reimbursement Consultants Inc,, Rutland Medical P.C. d/b/a MedicalNow, and Nexray Medical Imaging, P.C. d/b/a Soul Ra- diology Medical Imaging are hereinafter referred to as the PC Defendants.

Plaintiffs also allege common law fraud and unjust enrichment and seek a declaratory judgment as to all past, present, or future bills. (id. {| 543-86.) Currently before the court is Allstate’s motion for a preliminary injunction to stay all 40 pending no-fault insurance collection ar- bitrations commenced against Allstate by Defendant Rutland Medical P.C. d/b/a MedicalNow (“Rutland”).? (See Not. of Mot. (Dkt. 37); Mot. to Stay (Dkt. 37-1) at 1, 14.) Additionally, Plain- tiffs request that this court waive their obligation to post security for the injunction. (See id. at 24-25.) 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 re- quest 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

2 Following the service of Allstate’s opening motion, Defendant Nexray Medical Imaging, P.C. d/b/a Soul Radiology Medical Imaging (“Nexray”) entered into a joint stipulation with Allstate agreeing to stay and enjoin its no-fault collection actions until the disposition of Allstate’s declaratory judgment claim against Nexray in this action. Judge Nina R. Morrison so- ordered the stipulation on November 13, 2023. (See Min. Entry dated 11/13/2023; see also Consent Motion to Stay and Enjoin Nexray’s Collec- tion Actions (Dkt. 34).) Accordingly, this court need not address the claims against Nexray pursuant to the So-Ordered Stipulation. 3 The following background is taken from the allegations of the Complaint and declarations submitted by Allstate in connection with this motion. The court also takes judicial notice of certain facts pertaining to Defendants Pierre, Moy, and Weiner because they are drawn from reasonable accurate sources, including public and published dockets. See 725 Eatery Corp. v. City of N.Y., 408 F. Supp. 3d 424, 456 (S.D.N.Y. 2019) (citing Fed. R. Evid.

promulgated pursuant thereto (11 N.Y.C.R.R. § 65, et seq.) (col- lectively, “the No-Fault Laws”), an automobile insurer is required provide certain no-fault insurance benefits (“Personal Injury Pro- tection” or “No-Fault Benefits”) to the individuals that they insure (“‘Insureds”). No-Fault Benefits cover up to $50,000 for reasona- ble expenses incurred for necessary healthcare goods and services resulting from automobile accidents. See N.Y. Ins. Law §§ 5102(a)(1), 5102(b), 5103; N.Y. Comp. Codes R. & Regs. (“NYCRR”) tit. 11 § 65-1.1. These benefits are provided “to en- sure that injured victims of motor vehicle accidents have an efficient mechanism to pay reasonable frees for necessary healthcare services.” (Compl. { 72.) Consequently, this legislative scheme is designed to “ensure prompt compensation for losses incurred by accident victims without regard to fault or negli- gence, to reduce the burden on the courts and to provide substantial premium savings to New York motorists.” State Farm Mut. Auto. Ins. Co. v. Herschel Kotkes, M.D., P.C., No. 22-CV- 03611 (NRM) (RER), 2023 WL 4532460, at *1 (E.D.N.Y. July 13, 2023)).4 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. See 11 N.Y.C.R.R. § 65-3.11 (a) (providing that the benefits may be paid only “directly to the applicant” or “upon assignment by the applicant... directly to providers of health care services”). Providers are prohibited from receiving No-Fault Benefits, how- ever, if they “fail{] to meet any applicable New York State or local

201 (b)-(d)). The court need not take judicial notice of the exhibits cited by Allstate, however, as the court considers those documents as part of the record on this motion. Id. * When quoting cases, and unless otherwise noted, all citations and quotation marks are omitted, and all alterations are adopted.

licensing requirement necessary to perform such healthcare ser- vices.” Id. § 65-3.16(a)(12); see also State Farm Mut. Ins. Co. v. Mallela, 4 N.Y.3d 313, 321 (2005). This includes, inter alia, that unlicensed professionals, ie., non-physicians, may not own of control a medical professional corporation; serve as a director or officer of said corporation; enter into any agreements with the corporation’s shareholders; and receive shares or otherwise de- rive economic benefit from the corporation’s professional services. (Compl. "| 81-86); see N.Y. Bus. Corp. Law §§ 1507-08; 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 pro- hibited from engaging in fraudulent activity, including ordering excessive tests or treatment not warranted by the condition of the patient, failing to maintain accurate records for patients, 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. {§ 8, 87, 95-102); see, e.g., N.Y. Bus. Corp. Law §§ 1503, 1507; New York Education Law § 6530; N.Y. Ins. Law § 5102(a). 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 of N.Y., 100 N.Y.2d at 861. 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 arbitration proceeding. See 11 N.Y.C.R.R. § 65-4.1, et seq.; N.Y. Ins.

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Allstate Insurance Company v. Pierre, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-company-v-pierre-nyed-2024.